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expert reaction to announcement that medicinal cannabis products are to be legalised

The home secretary has written to the chair of the Advisory Council on the Misuse of Drugs about scheduling of cannabis-derived medicinal products.

 

Dr Steve Alexander, Associate Professor in Molecular Pharmacology, University of Nottingham and member of the ACMD working group considering the scheduling of Cannabis-derived drugs said:

“The first thing to note is that Cannabis is not a ‘drug’, it’s a natural product, which has been described to have over 100 apparently unique metabolites (cannabinoids), as well as many other bioactive metabolites found in other species (some of these are terpenoids). It is, therefore, a complicated mixture of potential drugs. The most prominent (in terms of scientific and medicinal attention) are the compounds abbreviated to THC (tetrahydrocannabinol) and CBD (cannabidiol).

“The spectrum of cannabinoids in Cannabis varies immensely, and so even rigorous clinical trials of Cannabis preparations in the past have been difficult to reproduce, which is one of the foundations of clinical medicine. The reproducibility issue is complicated further by variation in the administration of Cannabis and individuals’ variation in the metabolism and response to cannabinoids. In the UK and elsewhere, there are Cannabis-derived medicinal products (botanicals) which are obtained from plants bred and grown under conditions of high reproducibility. The preparation and isolation processes are to Good Manufacturing Practice standards so that the medicinal product has a defined, consistent content. For example, there are preparations available with defined doses with all the permutations of zero/low to high THC in combination with zero/low to high CBD.

“The current scheduling of Cannabis in the UK is that it is a Schedule 1 drug. This scheduling level (which includes raw opium, MDMA and LSD) can be defined as drugs which have no medicinal value. This scheduling places a barrier in the way of evaluating the potential medicinal value of Cannabis-derived preparations in the UK. A re-scheduling of Cannabis-derived preparations of known, reproducible, ‘pharmaceutical quality’ should allow rigorous, systematic analysis of the potential benefit (or harm) of Cannabis-derived drugs, which may later be licensed for medicinal use.”

 

Dr Tom Freeman, Senior Academic Fellow, King’s College London, said:

“The Home Secretary should be commended for his decision to remove cannabis-based medicinal products from Schedule 1. By commissioning two reviews, the Home Secretary was able to inform his decision using scientific evidence, clearly showing that cannabis-based products have medical value. This decision will be widely welcomed by the research community. A recent survey carried out by British Association for Psychopharmacology (BAP) found that Schedule 1 restrictions were hindering scientific research at all levels. Those who worked with Schedule 1 drugs reported significant delays, costs and uncertainty, leaving some to abandon this line of research altogether. The BAP survey reported that research using Schedule 2 drugs (where cannabis-based medicinal products will now be moved) was not hindered by current regulations. The Home Secretary’s decision will have a substantial impact on research by facilitating the development of safer and more effective medicines. As pointed out by the ACMD’s recent review, it is important that cannabis is not seen in isolation but as an example of a wider issue of potential ‘barriers to research’ associated with drugs listed in Schedule 1.  In light of the efficiency with which cannabis products were reviewed – and the clear conclusions reached – similar reviews are now warranted for other Schedule 1 drugs with potential medical value, such as MDMA and psilocybin.”

 

Ian Hamilton, Lecturer in Mental Health, University of York, said:

“This appears to be a very conservative decision by the Home Secretary as he could have opted for a lower schedule. Unfortunately this adds to the lack of credibility in the approach to cannabis policy as everyone knows that opiates and cannabis pose different risks yet they are now both schedule 2 drugs.”

 

*https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/729819/Government_response_to_the_ACMD_-_cannabis_derived_medicinal_products.pdf 

 

Declared interests

Dr Tom Freeman: “None”

Ian Hamilton: “No conflicts”

None others received.

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