Sam Mountney, Senior Policy & Campaigns Officer at Epilepsy Action, shares his experience on cannabis-primarily based medicines as a therapy for epilepsy in the UK
Cannabis has continued to divide opinion due to the fact the government rescheduled cannabis-primarily based medicines in November 2018, legally permitting them to be prescribed. Prior to this cannabis and cannabis derivatives have been largely classified as schedule 1 controlled substances, with an connected narrative centred on prohibition, addiction and possible adverse well being effects.
This law alter has led to an increasingly informed and nuanced discussion focussed on the scientific details and clinical proof about the possible advantages of cannabis-primarily based medicines to treat a quantity of lengthy-term well being circumstances, like epilepsy.
For context, cannabis-primarily based medicines is a blanket term for items containing cannabis or cannabis derivatives that are created and regulated as medicinal items for humans.1 As with most medicines, it is two active compounds present in the cannabis plant, particularly cannabidiol (CBD) and tetrahydrocannabinol (THC) that are of clinical significance and the existing concentrate of debate.
CBD, a non-psychoactive cannabinoid, appears to be following in the footsteps of turmeric and aloe vera in its portrayal by some as the subsequent holistic super supplement. In comparison THC, a psychoactive cannabinoid connected with the sensation of finding ‘high’ in the recreational context, continues to be viewed with caution.
There are a myriad of CBD items out there as more than the counter ‘supplements’ sold in well being meals shops across the nation. These items are not of a pharmaceutical typical and by law can not claim any healthcare advantages. They normally include really low quantities of CBD and have no notable clinical effects.
Having said that, there is excellent high quality clinical proof for the security and efficiency of CBD-containing medicine Epidyolex as an add-on therapy for two serious and life-limiting intractable epilepsy syndromes, Lennox-Gastaut and Dravet syndromes. This proof is in the type of Randomised Controlled Trials (RCTs), the ‘gold standard’ of clinical proof. The existence of good RCT proof has paved the way for Epidyolex to move towards UK industry authorisation. It has currently received industry authorisation for these indications in the U.S.
The lack of such proof for other cannabis-primarily based medicines, specifically these containing each THC and CBD, is proving to be a important stumbling block to access for men and women with epilepsy.
The highly effective and compelling stories of Billy Caldwell and Alfie Dingley, two young boys with serious and therapy-resistant epilepsies, became front-web page news in the UK final year and played a important function in the alter in the law. Each had been treated with cannabis-primarily based medicines containing THC and CBD abroad and showed notable clinical improvements in seizure manage and high quality of life. Tireless campaigning by their mothers led to each kids becoming prescribed medicine containing each THC and CBD on the NHS. They stay the only two NHS prescriptions of this kind that we are conscious of.
It is a bitter irony for several men and women impacted by serious and therapy-resistant epilepsies that the really cannabis-primarily based medicines that led to the alter in the law are as inaccessible now as they have been prior to. In spite of THC’s incarnation as a chemical bogeyman, several households of kids impacted by serious epilepsies are convinced that medicines with a 1:20 or 1:1 ratio of THC: CBD are the most powerful. This is not without having basis. Other G7 nations, most notably Canada and the United States, and European Union Member States such as the Netherlands, let varying degrees of access to treatment options containing each THC and CBD for epilepsy. In the Canadian instance, the lack of RCT proof is weighed against information from observational trials, pre-clinical research and out there proof on the endocannabinoid method and epilepsy.two
Initial interim clinical guidance for each paediatric and adult epilepsies propose against prescribing items containing THC and CBD in practically all situations. Current draft guidance from the National Institute for Overall health and Care Excellence (Good), which will eventually supersede the interim guidance, indicates this is unlikely to alter. A separate Good technical appraisal procedure is ongoing in respect of Epidyolex to treat Lennox-Gastaut and Dravet syndrome and a choice is anticipated later in 2019.
Epilepsy Action is in comprehensive agreement with clinicians, regulators, and the government about the require for additional higher-high quality analysis. A current NHS report3 indicates the strongest commitment so far to move this analysis forward at pace. Commitments of political will and, crucially, funds for essential analysis are welcome, but they should be followed by means of.
Practically a year just after the alter in the law, individuals stay unable to access cannabis-primarily based medicines for epilepsy in all but a minority of circumstances and the debate continues. In a single respect, the require for higher-high quality clinical proof is a routine and required debate about access to medicines. In an additional, this debate is one of a kind in attempting to unpick decades of prohibition and instigating a battle among avid campaigners calling on compelling anecdotal proof and international analysis to push for quick access, and a UK regulatory method that will seemingly only accept the elusive gold typical RCT proof.
Epilepsy Action is committed to making sure men and women with epilepsy can access the most effective drugs at the appropriate time. Although by no implies a magic bullet, the hopes of several impacted by serious and therapy-resistant epilepsies are firmly hung on cannabis-primarily based medicines. Hope is normally in quick provide for these men and women and there is a clear require for a quick-term answer to let compassionate access for these who could advantage. The time for waiting is more than, the time for action is now.
1 https://www.england.nhs.uk/medicines/assistance-for-prescribers/cannabis-primarily based-items-for-medicinal-use/cannabis-primarily based-items-for-medicinal-use-regularly-asked-concerns/what-is-a-cannabis-primarily based-medicinal-solution
three https://www.england.nhs.uk/wp-content material/uploads/2019/08/barriers-accessing-cannabis-primarily based-items-nhs-prescription.pdf
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Supply: https://www.openaccessgovernment.org/cannabis-primarily based-medicines/75938/