At the start of 2018, very few people could have predicted that the embattled and Brexit-obsessed minority government of Theresa May would find the time to address the controversial issue of cannabis, let alone have the stomach to set a new direction. But in politics, personalities always matter, and the man who unexpectedly became Home Secretary in April, and a brave single mother from Country Tyrone, played pivotal roles. Their actions fuelled a fast-moving story that caused a media frenzy, an urgent statement to Parliament, and a series of official steps that suddenly made medical cannabis in the UK a realistic near-term prospect.
Credit needs to go to the extraordinary campaigning of the Caldwell family, supported by the philanthropist Paul Birch, and the bravery of Sajid Javid in overturning a stale political consensus, despite the apparent discomfort of the Prime Minister and the bureaucratic inertia of a security department not known for doing the right thing in response to an individual case and doing it swiftly. Exactly how this came to pass and how the UK, over the course of one summer, managed to go from being a distant prospect for reform, to one of the most important and exciting European countries for the medical cannabis sector, is a whole other discussion. But where do these events now leave us when it comes to medical cannabis in Britain?
Now living in British Columbia, I am constantly reminded of how far ahead Canada is on the issue of drug law reform, but also how interested many policy-makers, investors and industry folk are in the UK. They have high hopes for this to become one of the most important medical markets within a few years and because of all the UK’s inherent strengths – an open market economy with a strong financial sector, a world leading life sciences industry, and publicly funded healthcare – they are right to be enthusiastic. But amidst the excitement and anticipation, it is time to pause and take stock. Many are talking like we have reached the destination already – as if a 40-year-old prohibition policy has been swept away in a few months.
In reality, we are not even at the end of the beginning, so it is important to realise where policy is today, so efforts to move forward with changes can be directed properly. Here are five key things to know about medical cannabis reform in the UK:
- Cannabis remains illegal. The Government is not legalising and regulating cannabis for recreational purposes. Nor is it simply allowing any cannabis-based product to be sold, or the plant to be grown at home by registered patients. No new laws have been tabled and the penalties in the criminal law remain intact. A comprehensive medical regime requires Parliament to approve secondary legislation – so-called statutory instruments – to revise scheduling and make defined products available at pharmacies. The separate argument about following Canada down the path of full legalisation is not one the May Government wants to even entertain – despite a recent high-profile intervention by a former party leader.
- Licensing has not started, and definitions of what qualifies as a cannabis-based medicine have not been set. The Health and Social Care Department and its regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA) are being asked to consult and then agree on what types of product should be licensed. However, that consultation has not started, and until a nationwide regime is in place and policy is set – including how products will be supplied, prescribed and dispensed throughout the publicly-funded NHS – those patients needing access must make do with an interim panel process. These applications are considered on a case-by-case basis, albeit fees have been waived and for emergency cases, processing times reduced to around two weeks.
- Doctors cannot currently prescribe, there is no new clinical guidance and many lack expert knowledge. Currently clinicians cannot make a cannabis recommendation, or issue prescriptions because there has been no new guidance issued and no products are available. The licensing regime will determine at what level doctors will be involved, and whether patients can access products over the pharmacy counter. Eventually, if individual GPs will be able to write prescriptions for cannabis-based medicines, then that access route will need a systematic programme of training and formal guidance to ensure fair access – and to overcome ignorance, clinical scepticism and general lack of familiarity.
- The securocrats are still running drug policy – for now. As it has been for a century, drug policy in Britain is set by the Home Office, also responsible for policing, borders and counter-terrorism. The structure of any medical system will be shaped by healthcare interests, but the final decisions will be taken by the Home Secretary. His view will be informed by a longer term review underway by the department’s advisory committee, the Advisory Council on the Misuse of Drugs (ACMD) – a process not slated to complete until July 2019. Unless and until drug policy is owned by the Health department, key decisions will continue to be governed, or at least skewed by, wider security concerns related to other controlled substances.
- Rules for import and export have not changed, and domestic cultivation permits remain highly restricted. Companies seeking licenses in the UK to import cannabis-based medicines or other raw material must still comply with the general restrictions on the cross border movement of controlled substances. If those products have a prior medicines record in another jurisdiction, that would not mean they will automatically qualify under the licensing regime being developed in the UK. Cultivators hoping to be the next GW Pharmaceuticals, need to apply for all the requisite licenses to grow cannabis plants on UK soil, and those permits come with a cost, and are only granted by the Home Office once very stringent tests have been met.
Progress has undoubtedly been made, but it is wrong to think that the mission to legalise medical cannabis in the UK has somehow completed already. There is a huge amount of detailed policy work and lobbying still required to ensure concerns are addressed and the right regime is crafted that can meet patient needs and the scale of demand expected. We need all those with the voice, expertise and influence to help policy-makers and regulators in the UK to make progress. Exchange of people and of knowledge will be most important between countries like Canada and Australia where several models for patient access have been tried and refined over the years, with a common law legal framework.
Learning from the international experience and creating a system that is robust, fair, and sustainable is now within reach, but it will not be achieved in one quick, simple step. The UK’s policy framework for medical cannabis will not be designed from scratch, but nor will it be imported wholesale. Ministers will only approve changes that have good evidence behind them, and that can be shown to work in the context of the UK’s unique legal and institutional conditions. In other words, medical cannabis reform, like in every other country, is not an event, but a journey, where even the final destination is not completely clear. But at least for the hundreds of thousands of patients who might benefit in Britain, that journey has now started.
Blair Gibbs is an Advisor for VolteFace and former policy advisor to the Justice Secretary Michael Gove (@BlairG1bbs)