January 2025
That heading is misleading (sorry), as this is a section of more questions and no answers, but here are some issues I don’t understand as an ex-nurse (not that I’m suggesting I knew everything, because I certainly didn’t), yet alone as a patient. You may have heard the terms Randomized Controlled Trial (RCT) and Gold Standard used together as RCTs remain the basis of whether something is ever likely to be deemed safe and available on the National Health Service (NHS). A Clinical Study can be a really useful indicator of the efficacy or behaviour of something, but it is not the same as an RCT. It might also be a really useful indicator, but also vulnerable to particularly biases that an RCT is not considered to be. Hariton and Locascio (2018)[1] embellish on its attributes, but they also point out how expensive it is, which to my mind causes a few problems. One is that although there is a lot of cannabis grown in britain, as the world’s biggest exporter [2], it’s largely for export, so not for treating patients here, whereas the vast majority of our private prescriptions are supplied by a variety of countries around the globe that are unlikely to have a vested interest in funding RCTs for us. My understanding is that there are still very few producers of cannabis that stays here, and it seems reasonable to assume that they won’t have the access to funds that a well established company might have. As Dr Mike Barnes points out (2024)[3], not only do they not have the funds, but much like the countries benefiting from exporting to us, there is no incentive for them either, because they can sell it as they do now. Sativex has been legally available on the NHS for years [4], so if you look up RCTs for cannabis, it’ll likely be Jazz Pharmaceuticals (previously GW Pharma), so they can afford trials and know how to make them happen. But it has still been reported widely to be a postcode lottery as to whether it gets prescribed (scarcely, it seems) and cost is generally cited, predictably, as a primary reason. So it also seemed reasonable enough to assume that any government, given the clear political bias against cannabis, would not be prioritizing funding RCTs for it either. Dr Barnes also highlights the challenge of measuring something as complex as cannabis anyway, as the RCT system is devised for pharmaceuticals. I’ve long thought that this was one good reason why it should never have been placed into the medical arena, as I’ve seen its lack of lending to so many components influencing dosing causing challenges to countries where they’ve done the same. There are no documented cases of overdose and the risk profile is lower than many things we can buy without seeing a doctor. But it has been medicalized, so here we are!
Another point is that unlicensed medications are given often on the NHS [5], to me, to lots of people I know and lots you’ll know. The only time I was given one, I think Amitriptyline for pain, I developed terrible night hallucinations, but I doubt it’s no longer prescribed that way out of concern for me. And nor should it be, but a massive part of the prescription system is weighing up risk. So why are we told it isn’t safe or efficacious enough for the NHS to prescribe? It has been for 3 people, and when you consider Sativex or Epidiolex [6], it has been for a long time. Unfortunately, these questions will likely remain unanswered as governments have the ultimate power and what they do doesn’t have to stand up to scrutiny. It’s just unfortunate that so many people suffer when they make mistakes of this magnitude. People’s lives and health should never be valued by money, nor ransomed for political gain, but it’s ugly that for now, they clearly are.
Hariton, E. and Locascio, J.J. (2018) 'Randomised controlled trials – the gold standard for effectiveness research,' BJOG an International Journal of Obstetrics & Gynaecology, 125(13), p. 1716. Available at: https://doi.org/10.1111/1471-0528.15199 [Accessed 5 January 2024]