Whilst there are many countries in Europe where possession of cannabis is decriminalized, such as Czech Republic, Switzerland, Spain and The Netherlands, in the UK, possession of the Class B drug is still illegal. It is expected, however, that the laws around cannabis may be relaxed within the UK, as in November 2018, specialist doctors were given the go ahead to prescribe cannabis-derived medicines.
A recent study showed that despite 72% of UK citizens with a disability or chronic illness claiming they experienced a great improvement to their symptoms when using cannabis, 43% of those suffering from medical conditions do not use cannabis to relieve their symptoms or pains, due to the drug being illegal.
The same study also showed that 54% of people living in the UK with a chronic illness, believed they should be legally allowed to purchase cannabis to help relieve symptoms.
A drug that contains two chemical extracts derived from the cannabis plant, called Sativex has previously received regulatory approval, but only available through private prescription in England. Used to treat epilepsy and multiple sclerosis, the drug is now available via NHS prescription.
It is expected that pharmaceutical companies will use cannabis to develop even more products which will help treat rare and catastrophic illnesses and conditions. So, it can be expected that the UK will follow in the footsteps of countries such as the US, the Netherlands, Germany, Austria, and Croatia which have legalized cannabinoids for medicinal use.
In this article, we explore how the use of cannabis within UK pharmaceuticals is expected to change, as well as the medicinal benefits offered by cannabis, and cannabinoids. Cannabinoids can be classified in three groups: phytocannabinoids, endocannabinoids, and synthetic analogues of both groups. There are many companies out there which are dedicated to developing and commercializing cannabis-based products and cannabinoid medicines, which will help with health issues such as skin conditions, epilepsy, multiple sclerosis (MS), and pain.
The importance of preclinical testing and clinical trials
Cannabis will undoubtedly be consumed recreationally for pleasure, but claims such as cannabis helping to cure cancer, relieve pain and reduce anxiety are ones which currently do not have an affirmative answer. Clinical testing of cannabis-derived products is vital for determining their safety and efficacy in humans with numerous indications – including those with limited or no currently available treatment options.
Various compounds and phytocannabinoids can be found within the cannabis plant, which have different effects. Preclinical research is needed, as the effects of each compound can be defined using in vivo (work that’s performed in a whole, living organism) or in vitro (performed outside of a living organism) models before introduced to human subjects. Then clinical trials are also vital for the discovery of the distinction between the effects and purposes each might be capable of. For example, cannabidiol (CBD) is the compound taken by those that suffer from epilepsy as it has been proven to prevent seizures, whereas tetrahydrocannabinol (THC) has been identified as a compound which reduces pain.
By regularly carrying out clinical trials on different compounds, for different conditions and health issues, the line between whether or not cannabis has medicinal benefits will soon become unblurred.
As mentioned before, cannabis contains many compounds as well as active ingredients called cannabinoids. Two of these – THC and CBD – are the active ingredients of a prescription drug called Sativex®. This cannabis-based medicine is taken orally via spray and is approved for use in the UK for adults to relieve muscle spasticity in MS.
Cesamet™ (nabilone) is an example of a legalized synthetic cannabinoid drug and is sometimes used to relieve sickness in people having chemotherapy treatment for cancer. It is currently prescribed by a specialist doctor to patients, only when other treatments to reduce nausea during chemotherapy haven’t been effective. Unlike Sativex, this cannabis-based medicine is taken as a capsule. In November 2019, a new medicine known as Epidyolex® (CBD) was approved for the NHS, allowing doctors to prescribe it to children diagnosed with severe epilepsy – Lennox-Gastaut syndrome and Dravet syndrome – which can cause multiple seizures a day. The oral solution contains CBD, but not the main psychoactive component of cannabis, THC. According to this BBC article, clinical trials have shown that children with these conditions who use the cannabis-based oral spray have experienced a 40% reduction of seizures.
Trials are currently underway to test cannabis-based drugs and their effects on conditions including cancer pain, the eye disease glaucoma, appetite loss in people with HIV or AIDS, and further research on epilepsy in children. This will involve research and development within drug discovery, preclinical trials and clinical trials.
Currently, in the UK, Sativex only has a license to treat MS spasticity, but some people report it helps with their other MS symptoms, including pain, bladder problems, difficulty sleeping and tremors (uncontrolled shaking of the leg or arm). It is expected that research and development projects will consist of looking further into how Sativex can be prescribed to help medical conditions other than MS. There is currently research looking at cannabinoids effect on relief from neuropathic pain as well as looking to provide relief from other medical needs.
As only a small percentage of promising compounds which are identified in early research end up gaining regulatory approval, clinical development and testing of cannabis-derived products can be both time consuming and expensive. There is funding available within the UK to support drug discovery and clinical trials activities. The R&D tax relief incentive offered by the government allows pharmaceutical companies to claim back costs associated with all four stages, from drug discovery through to post-launch.
While some cannabis-based products are available to buy over the internet without a prescription, currently, most patients in England will have to go without, or pay for it privately. With the recent news of Epidyolex and Sativex existing as the first two cannabis-based drugs to be approved for use through the NHS, it can only be predicted that the laws on cannabis will have to be “relaxed” in the near future.
In the past, most doctors have been unwilling to write prescriptions for medicines because, unlike the recently approved Epidyolex and Sativex, cannabis-based medicines have not been through controlled trials. In addition to this, multiple sclerosis charities argue the guidelines from NICE do not go far enough, so backlash like this makes acceptance of cannabis-based medicines more challenging.
Very few people in England are likely to get a prescription for medical cannabis. Currently, it is only likely to be prescribed for the following conditions:
- Children and adults with rare, severe forms of epilepsy
- Adults with vomiting or nausea caused by chemotherapy
Health stores sell certain types of "pure CBD". However, there's no guarantee these products will be of good quality. Furthermore, they tend to only contain very small amounts of CBD, so it's not clear what effect they would have.