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Those 16,000 people are ambassadors for educating the medical profession

Professor Mike Barnes ushered in the era of medical cannabis in Britain when Alfie Dingley – a child who suffered up to 150 epileptic fits a week – was prescribed cannabis on the NHS in 2018, paving the way for a change in the law.

Medical cannabis expert Professor Barnes led the team which successfully negotiated the prescription for Alfie.

He says, ‘I worked with the Home Office for three months and he got medication on the NHS in summer 2018. Really as a result of the publicity around that, the Government changed the law in November 2018.’

Under the new law, medical cannabis was rescheduled to Schedule 2, meaning it could be prescribed in the UK. This April, Alfie Dingley’s family said that Alfie had enjoyed two years free of seizures thanks to cannabis.

For Professor Barnes, a neurology expert, it was the culmination of a journey lasting two decades.

He says, ‘My interest in cannabis started about 15 or 20 years ago, when I got involved with developing the licenced cannabis medicine Sativex.’

Sativex is an oral spray which delivers both CBD and THC, two of the ‘active ingredients’ in cannabis, and is used to treat neuropathic pain and spasticity (muscle stiffness and spasms) from multiple sclerosis.

He said, ‘That got me interested in cannabis. In 2016, I was asked to do a report for the All Party Parliamentary Group on Drug policy. That rekindled the medical cannabis debate – and led to me being approached to help Alfie.’

Barnes is the author of more than a dozen books including The Beginner’s Guide to Medical Cannabis, and more than 100 academic papers. He says that despite the change in the law, it remains frustratingly difficult for doctors to prescribe medical cannabis on the NHS.

 

He says, ‘The government has made it quite difficult to do so. If a doctor wants to write a prescription, he or she has got to get it approved by a peer panel. It’s unheard of, a doctor having to have their prescription checked and verified and approved.’

This has led to doctors being reluctant to prescribe cannabis, Barnes says. He says that the NICE (National Institute for Health and Care Excellence) guidelines, used by hospital trusts to decide whether to prescribe medicines, are ‘rather anti-cannabis’.

He says, ‘The NICE guidelines are meant to be just guidelines, but they’re effectively mandatory. We’re lobbying to get a different view from NICE, looking at the real world evidence for cannabis rather than the pharmaceutical evidence for cannabis. Because it’s not a pharmaceutical product. If you look at it as a plant, there is massive evidence that it is efficacious, but NICE looks at it as a pharmaceutical. They’re not set up to assess a botanical.’

Barnes says that part of the problem is an ‘inbuilt conservatism among British doctors’, with organisations such as the British Paediatric Neurology Association speaking out against medical cannabis. He says, ‘There’s been a lot of very unhelpful propaganda and antagonism from some of the hierarchy.’

One of the key barriers, Barnes says, is educating doctors about the ways cannabis works in the body. Medical schools still don’t teach how cannabis works, Barnes says – which means doctors often lack a basic understanding.

He says, ‘It works in the endocannabinoid system, which is inbuilt in all of us and all vertebrates. Doctors aren’t taught about that. Medical schools, bizarrely, have known about it for 30 years, and it’s the most important master controller, neurotransmitter system in the body. But it’s not talked about. So doctors just don’t know about cannabis medicine.’

Medical schools still don’t teach how cannabis works, Barnes says – which means doctors often lack a basic understanding.

Barnes says he was initially cynical about cannabis himself, when developing the drug Sativex – but now says that it works ‘exceptionally well’ for conditions such as chronic pain and anxiety.

Barnes says that while 16,000 patients are now being prescribed medical cannabis privately in Britain, it’s still growing relatively slowly.

But over the next five years, he’s optimistic that patient pressure will see a change in the way the NHS treats medical cannabis.

Barnes says, ‘I am very much a natural optimist – if I wasn’t, I wouldn’t do this damn cannabis stuff! I think it will take two, three or four years and it will begin to break into the NHS.’

Barnes believes that public education is key, and that once patients realise that medical cannabis is an option for chronic pain or chronic anxiety, it will put pressure on doctors – and force them to learn about medical cannabis.

He says, ‘I’ve trained 200-plus doctors now. But there are now 16,000 patients, the vast majority of which have benefited from it. They will go back to their friends, to their relatives, to their doctors, to their GP saying, “I tried cannabis, even though you told me not to and look, it’s helping.” And any sensible, intelligent doctor will think, “Well, maybe I got that wrong.” I look at those 16,000 people as ambassadors for educating the medical profession.’