In November 2018, the UK legalized medical cannabis, enabling specialist doctors – such as neurologists or pediatricians – to prescribe the plant-based medicine for any condition.
It was a landmark decision predominantly inspired not by any of the scientific evidence on medical cannabis but by stories from parents who realized their children needed this medicine.
“Having been moved by heartbreaking cases involving sick children, it was important to me that we took swift action to help those who can benefit from medical cannabis,” said then-Home Secretary Sajid Javid at the time.
Today, approximately 500 patients are being prescribed medical cannabis in the UK, says neurologist Michael Barnes, MD, who was the very first doctor to write a cannabis prescription in the UK, and has since become one of the top leaders in the country’s medical cannabis efforts.
“We have progressed, and yet sometimes I get very frustrated at how slow it is, but that’s looking back 19 months – we’ve come a long way,” Barnes says.
Barnes, who is Chief Medical Officer at LYPHE GROUP and Chair of The Medical Cannabis Clinicians Society, shared with Green Flower some of the key issues slowing the advance of medical cannabis in the UK as well as a closer look at how it became legal in the first place and what needs to happen next.
When the law changed in the UK, enabling specialist physicians and practitioners to prescribe medical cannabis, it was the result of a very successful media campaign, Barnes explains.
The campaign was largely led by Hannah Deacon on behalf of her son Alfie, who became the first patient in the UK to receive a permanent medical cannabis license under the guidance of Barnes.
“It was Alfie’s story that changed the whole government’s approach to cannabis. Not the scientific evidence,” Barnes notes. “In the U.S. it was Charlotte Figi.”
This is why, in addition to educating doctors on the scientific nuances of medical cannabis, Barnes believes one of the greater keys to progress is educating the public. “Because it’s the public, through the media, who will change people’s minds. I don’t think science is actually the way to move forward for changing big agendas, it’s media that changes big agendas. It’s media that changes people’s minds – certainly politicians’ minds.”
Ninety percent of the UK’s healthcare is through the National Health Service (NHS), which is the public sector. “The NHS can prescribe medical cannabis but is not at the moment. The only prescriptions written are in the private sector, which is sad really because right now cannabis is very expensive for patients,” says Barnes, who is also Chair of The Medical Cannabis Clinics in the UK. “It’s expensive because so few prescriptions are being written and also because each prescription has to be imported individually, which clearly adds to the cost.”
Just before COVID-19 came along, the government had changed its mind to allow mini-bulk importation, Barnes explains. “Not massive amounts at all, but no longer limited to one patient at a time. And then of course COVID came and it really affected the supply chain because all of our cannabis in the UK is from abroad at the moment. Getting things in from abroad has been very difficult in the last few months.”
While the progress seems painfully slow, things have indeed come a long way since January.
“We know, according to a study, that about 1.3 million people in the UK use cannabis every day for medical purposes, so we have a huge way to go yet there are positives,” Barnes notes.
“We’ve gone up to 500 patients when really there were almost none before January of this year. What’s more, eight cannabis producers can import in the UK now, including from Canada, Australia, Israel, and Holland – all that has helped drive the price for patients down to about half of what it was.”
Another important number: only 27 doctors are currently prescribing cannabis in the whole of the UK, Barnes says. Through training and education, he hopes to have 100 prescribing physicians and practitioners by the end of the year.
While Barnes agrees that the government could help further support and grow the cannabis industry in the UK, most of the negativity – perhaps the greatest sticking point – comes from the medical establishment.
“It’s changing, but in many quarters people are still very negative, particularly within some of the societies like the British Pediatric Neurology Association – those people are very negative,” Barnes explains. “I don’t know why, but my guess is they have been brought up in an age of restriction, demonization, and criminalization of cannabis. In their view, cannabis is an unsafe thing that causes people to go psychotic. It couldn’t possibly be a medicine.”
Barnes has observed physicians calling cannabis a mere placebo effect. Remember Alfie? When he went from having about 300 seizures every month to zero seizures on cannabis, his primary doctor said it was just a placebo effect, Barnes recalls. “The ignorance of some doctors is mind blowing, although it’s changing.”
To date, Barnes has trained about 60 doctors in the UK, and the barriers are coming down. He sees a lot of pain doctors taking interest, as well as psychiatrists who have found cannabis useful for anxiety and PTSD.
Meanwhile, he has heard pediatric neurologists suggest ketogenic diets and even brain surgery as a prerequisite before even giving cannabis a try – and only Epidyolex at that because it’s the only licensed product.
“What I would really like to see is those doctors who are reluctant to open their minds to be trained, to at least open themselves up to the possibility of referring to prescribing doctors who do know what they’re talking about,” says Barnes, who is also Director of Education for the Academy of Medical Cannabis.
“The big sticking point for medical cannabis in the UK right now is definitely the conservative nature of the senior members of the medical profession, those who are in positions of power and authority and yet remain closed to the idea of medical cannabis.”
Barnes believes that when doctors are reluctant to get curious about cannabis, they usually see it simply as an excuse to get high or they don’t like the concerns of psychosis – as tiny as the risk may be.
“They’re ignorant. And I don’t mind people ignorant as long as they admit their ignorance and are willing to learn,” Barnes says. “What we don’t want is the senior doctors in this country being ignorant and spouting such ignorance as though they are certain about it. Open ignorance is okay, closed ignorance is not okay.”
Doctors have a duty to care for their patients, Barnes continues. Whether it’s conditions like chronic pain or epilepsy – if there is something there where the evidence shows that it helps, you have a duty to enable that patient to try it, he says. “Whatever you personally think, your own morals, shouldn’t come into it. If a patient thinks that it’s reasonable, you should educate them, and say okay let’s try it for you. Instead we have many doctors imposing their own morals or ignorance on the patient, which is just totally wrong.”
Despite the hardships and close-minded ignorance, Barnes is confident that the barriers will continue to break down.
“Looking at the timeline Canada went through. It took three or four years for the medical establishment to at least accept cannabis as a medicine. And we’re only in the second year here,” he says. “I give it another one or two years, and it will see more acceptance in the medical profession.”
Education is absolutely key for both medical students and current physicians, Barnes emphasizes. He points out the private sector has a huge role to play in getting more prescriptions out there and getting more people to promote the cause. And Barnes hopes that general practitioners will also be able to legally prescribe cannabis.
“I’m sad medical cannabis is only in the private sector because it’s unaffordable for a large amount of the population, but at least these people are getting prescribed, they’re going back to their hospitals, back to their GPs and saying, look it’s working,” Barnes notes.
“And maybe that in itself will slowly change the mind of doctors who are refusing to prescribe at the moment.”
In addition to getting more doctors on board through patient success stories and education, Barnes also points out that due to COVID-19’s impact on the economy, the government has all the more incentive to help get the UK’s cannabis industry up and running.
“We’ve formed a new organization called UKCann, which is basically an organization to promote the UK cannabis industry and lobby government to make the application process simpler,” Barnes explains. Part of the goal here is to make the application process easier for farmers and greenhouse owners who might want to switch to producing cannabis.
“This will be really important given the impact of COVID because it will create jobs and help the people, but also create tax revenue for the government,” Barnes notes. “We’ll need to stimulate the economy, and this is one way of doing that. The government needs to think this through, to help cannabis develop into a new industry.”