Thursday 8 March 2018

It is time to Reschedule Cannabis

The use of cannabis for medicinal purposes is common and the evidence that it is efficacious for several medical conditions is now very strong: Medical Evidence

It is illogical to continue categorising the drug under Schedule 1 of the Misuse of Drugs Act.


Schedule 1 Drugs:

Drugs belonging to this schedule are defined as having no therapeutic value and therefore cannot be lawfully possessed or prescribed. These include LSD, MDMA (ecstasy) and cannabis. Schedule 1 drugs may be used for the purposes of research but a Home Office licence is required.


One of the main impacts of this schedule that is that it makes doing research into the benefits of cannabis all but impossible for most. I saw this for myself whilst working at Cancer Research UK in 2013 to investigate the oncological potential for cannabis: The project had a budget of £150k and would take approximately 2 years to complete. However, once the time and costs to get a license along with the required security needs had been added along with the time it would take to source the exact materials/cannabis required for the project had been added; the project would now take more than 4 years and would cost £315k! So the project was rejected - this has been happening all over the UK and for many years.

In addition, Schedule 1 means that doctors can neither be officially taught about the benefits of cannabis nor discuss consumption with patients other than in order to warn them of the dangers or else risk losing their license to practise. Afterall - since the schedule defines cannabis as having no recognised therapeutic use - why would doctors (or patients) need to know anything about it?

There is a similar impact on government departments as well as registered charities who both risk their licenses if they engage on the subject openly which is why it took so long for and charities to come out publicly in support of cannabis as medicine: A very big "Thank you" to The MS Society for their courage. We hope more will follow....but you can bet they will, the moment cannabis is out of schedule 1!

Watch this great little clip produced by The Beckley Foundation on the inconsistency of our current scheduling of cannabis:

The UK is the world's largest producer and exporter of legal cannabis for medical and scientific use. Yet its drug laws are inconsistent and contradictory, criminalising thousands of patients who use it to treat chronic conditions.


Schedule 2 or Schedule 4?

Release have a really good article that details the differences between the schedules.

Being that the only current approved cannabis medicine, Sativex, is currently in Schedule 4(i), this would seem the most logical and sensible place to put cannabis too, and if it were up to me, or up to most informed opinion, then this is what should happen, but the proposal from Paul Flynn's Elizabeth Brice Bill is proposing only the smallest of changes which would place cannabis into Schedule 2.

Here is the entire text of the Bill:

Rescheduling of cannabis and cannabis resin
The Misuse of Drugs Regulations 2001 are amended as follows.

In paragraph 1(a) of Schedule 1, omit “Cannabis (not being the substance specified in paragraph 5 of Part 1 of Schedule 4) and cannabis resin”.
In paragraph 1 of Schedule 2, after “Bezitramide”, insert “Cannabis (not being the substance specified in paragraph 5 of Part 1 of Schedule 4) and cannabis resin”.

Why not Schedule 4 like Sativex?

In 2012 Schedule 4 was split into 2 parts (i) and (ii) so that certain medicines, such as Sativex and benzodiazapines, could be more strictly controlled without making them so difficult for doctors to prescribe due to all the approvals, documentation and licenses required for Schedule 2 substances. Since this point in time, from a legal and possession standpoint, Schedule 2 and Schedule 4(i) are now the same:

Schedule 4(i) drugs can only be lawfully possessed under prescription. Otherwise, possession is an offence under the 1971 Act.
So in actual fact, Sativex, without a prescription is treated as a schedule 2 substance

Ok - so what about all the approvals, documentation and licenses required for doctors to be able to prescribe - surely this will seriously restrict access and discourage doctors from prescribing?

Well until a few months ago, this would have been true, however, since some of the more powerful opioid derivatives such as Fentanyl and Carfentanyl were added to Schedule 2, it was necessary to make some changes to the way this worked too, or else many thousands of patients in the UK would lose access to their pain relief. So the process for doctors wanting to prescribe a schedule 2 substance was significantly simplified and automated and can now be done with a few clicks of a mouse.

The upshot of all of this is that to all intents and purposes, the only difference between Schedule 2 and Schedule 4(i) is that there is an obligation to record and track prescriptions which, frankly, would be a huge benefit for cannabis, as we really don't currently have all the patient data we need and this will help us gather it.

So whether cannabis is moved to Schedule 2 or Schedule 4(i) makes little or no difference and the only practical difference being data collection, this is a benefit to the future of cannabis as medicine in the UK.

What does this mean for Legal Access to Cannabis Therapeutics

Once cannabis has been moved out of schedule 1, it becomes possible for doctors to be able to legally write prescriptions for cannabis and with a few minor tweaks to a few import regulations (no law change involved) for those prescriptions to be fulfilled at a licensed pharmacy. In terms of what forms of cannabis would be available will depend on future policy in the UK but now that there are so many suppliers/producers of quality cannabis medicines in all forms, such as Flower or bud and cannabis oils, extracts and edibles and from international cannabis pharmaceutical companies like, Bedrocan in the Netherlands, Tikum Olam in Israel, Columbia Care in the US, Tilray in Cananda with more and more coming on board all the time there is certainly little need to fear too limited a range of products, though it might be fair to suggest that in the UK, we may start with just a few and increase the range as time goes by. But, to reiterate, this is speculation at this stage and the question is unlikely to be addressed before or even alongside rescheduling.

How will the effect patients who choose to Grow Their Own Cannabis?
None of this will have any direct impact of those of us who choose to grow and produce our own cannabis medicine. Whether in Schedule 2 or in Schedule 4(i) - the situation is identical to the end consumer or grower - However - there is cause for some hope here too, thanks to the quite unique limitations on how our police force operates in conjunction with the Crown Prosecution Service (CPS)

Imagine, for a moment, that sometime after patients in the UK can legally access and consume a cannabis flower product, by prescription. Then imagine 3 cannabis consumers in a room.

Person 1 is in possession of Bedrocan (cannabis flower) and is consuming that.
Person 2 is in possession of some street weed they just bought and is consuming that.
Person 3 has some they grew themselves and is consuming that.
If those 3 people stay quiet when the police are called to the scene - they are not going to know, who is doing something illegal and who is not, based on sight alone and as such, can no longer make a "safe" arrest. Reasonable suspicion is no longer reasonable!

There are legal teams and QCs looking into this as I write this article, but the likely upshot of this could be that once legal forms of flower have been introduced into the UK, personal possession and even personal GYO could become tacitly and logistically decriminalised. Of course, as above, we will not be able to get a definitive answer on this, until after it has happened and the first "test case" happens.

In any and all eventualities and no matter what sort of future any of us want for cannabis in the UK, absolutely nothing can or will change without moving it from Schedule 1 of the Misuse of Drugs Act, and even the smallest of changes to Schedule 2 has hugely positive implications, which I strongly suggest is the very first domino to fall which will cause, over time, all the rest to fall too.

Jon Liebling

Political Director - United Patients Alliance