Last June, under huge and hysterical media pressure, Home Secretary Sajid Javid opened the lid on the Pandora’s box of ‘medicinal’ cannabis. He issued emergency licences to allow access for two young boys with severe forms of epilepsy and at the same time ordered a review into evidence of its therapeutic efficacy, falling for what soon transpired to be a well-orchestrated campaign. Coordinated by Volteface, the openly pro-legalising recreational cannabis think tank funded by Paul Birch, a multi-millionaire British tech tycoon, it was aided by the journalist and campaigner Ian Birrell, who has disclosed his membership of its advisory panel. Mrs Caldwell and her sick child had, the Daily Mail argued, been hijacked by a pro-cannabis lobby that stands to make billions. She herself has a vested interest as the director of a company marketing cannabis oil which she sells online.
With useful idiots like Lord Hague ready to make two and two add up to five by arguing that the current law is indefensible and therefore we must legalise cannabis altogether, the campaign had got off to a flying start.
Since then the media onslaught of the metro-elite’s demands for legal access to this drug has not stopped. Fuelled by Canada’s ill-considered decision to legalise recreational use, it reached peak volume last week. Kate Andrews of the Institute of Economic Affairs made her case for it based on a startlingly under-informed account of post-legal pot Colorado (she cannot have read the latest impact update) and arrest stats from the American Civil Liberties Union. Whatever their reliability, she should know that here you are unlikely to receive a custodial sentences before at least seven previous convictions or cautions, and that 50 per cent sent to prison for the first time have at least 15 ‘previous’. As to cannabis possession, it is a myth that is anything other than decriminalised already.
Then we had former Met Chief Lord Hogan-Howe adding his pennyworth. He has no reason not to know the devasting evidence from Colorado and Washington State, yet he thinks we need a two-year review of legalisation. Philip Collins of the Times seems equally gung-ho about Colorado’s descent into a dangerous drugs products free-for-all.
In the most sickeningly selfish article of all, the gloating Simon Jenkins raised his ‘glass of cannabis wine’ to the drug culture that no legalisation will ever sanitise.
Unmentioned was that Canada’s decision was based on no evidence at all that it would either reduce youth use or meaningfully curtail the black market, the stated goals for taking the country down this path
Nor was the fact that Canada’s ‘journey’ had started – where else? – with medicinal cannabis, the cannabis lobby’s admitted and cynical strategy to buy the drug a good name and lower the public’s defences.
This is the wheeze our Home Secretary has fallen for. He has already made good his promise of June 26 and given the all-clear for clinical specialists routinely to prescribe cannabis oil and similar products for epilepsy and multiple sclerosis. Taking effect on November 1, this decision is based on the hastily prepared recommendation of his Chief Medical Officer, Dame Sally Davies, that vaguely designated ‘cannabis based medicinal products’ should be ‘rescheduled’ (in other words, legalised for ‘prescription’).
This comes before the Advisory Council on the Misuse of Drugs (ACMD) recommendations have been followed through for a clear definition of what a cannabis-derived medicinal product is, and ‘additional frameworks’ and clinical guidance for ‘checks and balances’ for safe prescribing.
Yet these are products neither clinically tested nor of proven efficacy, which doctors will be under great pressure to prescribe and which will leak into the illegal market.
In this one misguided action, oblivious to those interests ruthlessly exploiting the medicinal cannabis pipe dream, the Home Secretary has casually trashed the UK’s world class and purposefully onerous pharmaceutical approval system.
The Home Secretary cannot have read the small print of Dame Sally’s review, or he chose not to, in his rush to get the Billy Caldwell story off the front pages. It has the hallmarks of a dodgy dossier. For the American evidence on which it relies states that there is ‘no or insufficient evidence to support or refute the conclusion that cannabis or cannabinoids are an effective treatment for epilepsy’.* Likewise the meta-analysis Dame Sally leant on provided her with no evidence for epilepsy.
The only ‘conclusive or substantial’ the American evidence finds is for the treatment of chronic pain in adults, chemotherapy-induced nausea and vomiting and for improving patient-reported multiple sclerosis spasticity symptoms. For these conditions the licensed cannabis-based drugs Sativex, Marinol and Nabilone exist.
Elsewhere the serious problems associated with the medicalisation of cannabis have been set out. The testimonial evidence it largely relies on falls short of the standards required for the approval of other drugs – which are ‘adequately powered, double blind, placebo controlled randomised clinical trials’.
Against this absence of evidence is the very real evidence of the drug’s harm which has presented itself again in rising hospital cannabis admissions. These include alarmingly high numbers of teens urgently admitted with psychosis. Had Dame Sally had taken more time, extended her search and listened to recent warnings, she would have found that this is far from the only public health risk associated with cannabis.
A long, well-written and referenced article in the BMJ by an Australian academic, Professor Albert Reece, entitled Known Cannabis Teratogenicity Needs to be Carefully Considered, published shortly after the Davies review, raises the alarming question of whether exposure to cannabis has significance for rising birth defects; and whether full-spectrum cannabis (unlike the FDA-approved drug Epidiolex) could have some of the problems of thalidomide.
Reece’s concern is that even were the clinical efficacy of cannabinoids to be demonstrated, ‘their teratogenic potential, from both mother and father’ would need to be carefully balanced with their clinical utility. A teratogen, for the uninitiated, is an agent that can disrupt the development of the embryo or foetus and halt the pregnancy or produce a congenital malformation (a birth defect).
Professor Reece reports that ‘gestational cannabis has been linked with a clear continuum of birth defects’ in a range of longitudinal studies, and increased foetal death, and reflects a worldwide increase in high cannabis-using areas.
He is not alone to be concerned. The website of NHS Wales carries a warning about cannabis which indicates that it is taking its gastroschisis (a condition in which the bowel herniates out of the abdomen during foetal development) outbreak seriously.
Professor Reece’s warning needs heeding. Only once before has a known teratogen been marketed globally: thalidomide. What the Home Secretary and his Chief Medical Officer need reminding of, as Reece makes clear, is that the thalidomide disaster is ‘the proximate reason for modern pharmaceutical laws’. These are laws that Sajid Javid, Dame Sally Davies and the AMCD are prematurely prepared to overturn.
Previously supportive commentators have begun to express their reservations about the implications of ‘medicinal’ cannabis. It can’t be allowed to become a free-for-all, writes Alice Thomson in the Times.
She is right to worry, and the dangers could be worse than anything she has imagined.
This is why the Home Secretary needs to stop and take stock. He still has time to review and revoke his ill-advised and media-pressured decision. As for the vested interests behind legalising cannabis, he should know that as far as medicinal cannabis is concerned more will never be enough.
*Epidiolex, the GW Pharmaceuticals CBD-based epilepsy drug which has recently been approved for Dravet Syndrome in the US and which we can expect to be approved in Europe, does not fall into this category. One must presume that GW Pharma with twenty years of research would have included the psychoactive ingredient that Mrs Caldwell and her campaign claim is necessary, had they been able to justify it clinically.