June 2018 has been a monumental month for medical marijuana. Epidiolex — a cannabis-derived drug produced in the UK by GW Pharmaceuticals — has been approved by the FDA for use across the US. The former leader of the Conservative party William Hague called for marijuana to be legalised in the UK. Sajid Javid — the current Home Secretary — announced a potentially game changing government review into the medicinal use of cannabis.
Potentially, we are in a pivotal period for medical marijuana in the UK. But how likely are we to see it prescribed in the near future? And is there substantial clinical evidence to support cannabis’ medicinal integration into the UK health sector?
To fully assess medical marijuana in the UK, and the potential impact it could have, the ethical concerns need to be separated from the science. To do this, we’ve looked into the clinical evidence.
Cannabis — the clinical case
One of the biggest issues around medical marijuana is the shortage of large-scale clinical trials into its effects. Part of the reason why this is the case is down to the drug’s illegal status in most western nations. In the UK, it is a class-B drug, whilst in the US it is viewed under federal law as being of no scientific value — in the same group as heroin and LSD. Persuading governments to release marijuana for research is, because of this, exceptionally difficult.
Despite this, some experimental clinical trials into the potential medicinal and therapeutic effects of marijuana have gone ahead.
Using marijuana to treat Epilepsy
Epidiolex, the drug recently approved in the US, is potentially a game changer in treating paediatric epilepsy with medical marijuana. The two strains of epilepsy that the drug treats —Lennox-Gastaut syndrome, and Dravet syndrome — have a higher mortality rate amongst young people than most other forms of epilepsy. Dravet syndrome, for example, didn’t have any specialised treatment until the FDA approved Epidiolex.
Clinical trials of medicinal cannabis into other forms of epilepsy have also taken place. In 2015, epilepsy specialists at NYU Langone Medical Center indicated that people with epilepsy could benefit from cannibidiol treatment. Unlike illicit cannabis, cannibidiol treatment only uses the therapeutic part of the plant, ridding the treatment from the psychoactive side of cannabis (THC).
Of the 213 people in the trial, there was a 50% reduction in the frequency of seizures for children and adults with specific forms of epilepsy.
Taking this study into account, medical marijuana could improve the lives of children and adults with epilepsy. More than 50 children in the UK have already received Epidiolex free of charge as part of a compassionate access system, for example, though it is not currently available on the NHS.
Cancer — could marijuana stop growth?
It is already widely accepted that marijuana can prevent the sickness that people suffer after receiving chemotherapy. But tests on animals have indicated a potential that reaches far beyond reducing sickness.
According to the National Cancer Institute, clinical studies have found that in mice, medical marijuana can stop the growth of cancer cells by blocking cell growth, and obstructing the development of blood vessels that cancer needs to grow. Similarly, a second study suggests that delta-9-THC — a form of medical marijuana — damaged and killed liver cancer cells.
It would be easy to get carried away with the potential of medical marijuana in helping with the treatment for cancer. Clearly, there is enough potential for further clinical trials. But more studies need to be done to assess its full impact for people suffering with cancer.
Marijuana — reducing the pain for Arthritis sufferers
Research into the benefits of medical marijuana for people suffering with arthritis have been going on for some time. As far back as 2006, clinical researchers tested cannabis-based medicine — Sativex — for efficacy in the treatment of pain. The study concluded that those who took Sativex had less pain and slept better at night.
Similar clinical tests on chronic pain and Multiple Sclerosis using Sativex produced equivalent results. For people suffering with long-term, chronic pain, cannabis-based medicine can help alleviate that pain, consequently improving their lives.
Will the public ever accept cannabis as medicine?
Whilst there are positive signs that medical marijuana can positively impact of thousands of lives in the UK, doubts still remain around two issues.
Firstly, will it ever be legalised in the UK? Secondly, will the public, even once legalised, accept a drug that has been demonised by the British media for decades? The first of those issues rests on the Sajid Javid’s government review. The second question is slightly trickier.
A 2016 poll by Populus revealed that 58% of politicians supported the use of cannabis for people battling medical conditions. Whilst a 2013 Ipsos Mori survey suggested that 53% of the public support cannabis law reform. Although there is no specific data relating to the public and medical marijuana specifically, people do seem to be willing to reconsider the role marijuana plays in society.
Ultimately, it remains to be seen whether any government will ever pass policy related to laxer drug policy. Potentially, it could be political suicide — at least that was the opinion in the past. But with the government review under way, support from MPs, and potential support from the general public, medical marijuana could be with us sooner than we think.
Taking a patient centred approach, those of us who work in the clinical industry would most likely want to ensure the true benefits of cannabis-based products on people suffering with chronic diseases are explored through some serious, in-depth clinical trials. But when it comes to medical marijuana in the UK, the future looks to be brighter than ever.
For more on the topic, check out England's chief medical officer's review on the Cannabis Scheduling.