Kevan Christie: Cannabis-based drugs may not be as useful as some believe

Six-year-old Alfie Dingley is carried by his father Drew Dingley along Whitehall in London before handing in a petition to Number 10 Downing Street asking for Alfie to be given medicinal cannabis to treat his epilepsy.
Six-year-old Alfie Dingley is carried by his father Drew Dingley along Whitehall in London before handing in a petition to Number 10 Downing Street asking for Alfie to be given medicinal cannabis to treat his epilepsy.
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The predictable calls for medicinal cannabis to be made available on the NHS to treat neurological conditions including epilepsy give politicians the chance to exhibit their “street cred” while latching on to a worthy cause.

Studies suggest CBD may benefit up to a third of people who have seizures that do not respond to current medication. However, the elevation of cannabis to a near-panacea should come with words of caution as it’s still early days in terms of research and a number of concerns must be addressed before cannabidiol (CBD) can enter the medical practice. Chief among these is safety.

In trials involving children with epilepsy, adverse side effects were reported in anything from seven per cent to 93 per cent of the participants and it is also unclear how CBD might interact with other drugs. And, as with all potential medicines, withdrawal and tolerance are issues that need looked at.

CBD contains virtually no THC (tetrahyrocannabinol), the component of cannabis that gets you high and is a pharmaceutical product not to be confused with other oils available online.

It is understandable why Edinburgh mother Karen Gray is campaigning to have it prescribed for her five-year-old son Murray who, like Alfie Dingley down south, suffers from “nightmare” seizures. In Karen’s case, she is prepared to try anything and is of the opinion that she has to obtain CBD for Murray.

The increased media coverage of the issue will lead to more calls for medicinal cannabis being made available on the NHS, though this is a decision that ultimately would rest with the UK Government as the licensing, safety and efficacy of medicines is currently reserved and is the responsibility of the Medicines and Healthcare Products Regulatory Agency which operates on a UK-wide basis.

At present a new drug application for cannabidiol has been submitted to the US Food and Drug Administration and, if approved, it is likely to be available for prescription later this year. Currently cannabis is legal for medicinal use or decriminalised for recreational use in more than half the states of the US, in more than 10 European countries and in Australia.

The NHS could provide more assistance for parents like Karen Gray who are contemplating giving their children CBD. Guidance on strength and dosage could be something that pharmacists could take on board and would sit well with the Scottish Government’s move towards a multi-disciplinary approach to primary care. Currently there is one licenced cannabis-based medicine in Britain, designed to reduce muscle spasms in people with multiple sclerosis (MS).

The mouth spray, called Sativex, contains two chemical extracts taken from the cannabis plant. It was licenced for use in the UK in 2010, but is not usually available on the NHS in England as it is deemed too expensive. It is, however, available to MS patients in Wales.

There has also been a case where a GP in Northern Ireland prescribed medical cannabis to an 11-year-old boy for his epilepsy seizures.

So doctors can, in exceptional circumstances, prescribe medicines containing CBD for a patient’s use. The need to help children with severe epilepsy at this stage probably outweighs the risks in terms of GPs prescribing cannabidiol but the research should be fast-tracked if possible. However the argument has shades of grey and is nowhere near as clear cut as some politicians are making out.