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Medical cannabis

Advisory body on drug misuse to provide framework on medical cannabis by end of 2019

Roger Knaggs says the reclassification of medical cannabis is like “living in a social experiment” and that prescribers need more information and evidence about what they should prescribe. 

Roger Knaggs, specialist pharmacist in pain management and recent appointee to the ACMD

Source: Charlie Milligan

Roger Knaggs says he isn’t surprised about the lack of medical cannabis prescriptions since its reclassification, warning that it will continue until prescribers have a clearer idea about what they should be prescribing

The Advisory Council on the Misuse of Drugs (ACMD) has been asked to provide an outline framework on medical cannabis by the end of 2019, with the aim of having an initial view by the end of 2020.

Roger Knaggs, specialist pharmacist in pain management and recent appointee to the ACMD, which is responsible for advising the government on the control of dangerous or otherwise harmful drugs, told The Pharmaceutical Journal that cannabis was “definitely” going to occupy a lot of the ACMD’s time “for a whole host of reasons”.

During the interview, Knaggs highlighted that when it comes to “cannabis-based products for medicinal use” and pain, “the evidence for benefit is very small but the evidence for … more serious harms, is significantly higher”.

“If you look at the number needed to treat, you need to treat between 20 to 25 people for 1 person to have good pain relief, but you only need to treat 6 patients for 1 to experience harm,” he explained, adding that there was a need for “better data” and a more thorough understanding of cannabinoid pharmacology.

He expressed his concerns that although initiatives in different countries had looked at the increasing availability of cannabis for medical purposes, each country’s approach had been slightly different and, consequently, we are “living in the middle of a social experiment”.

“Nowhere, so far, has really evaluated what the impact of these changes to classification and availability have had,” he said, adding that, from a prescribing perspective, a “big question” still remained around dose.

“We just don’t know what the right dose is, and, also, what the right combination of these compounds is for an individual person — what would you write the prescription for?”

Knaggs added that he was not surprised by the lack of prescriptions for medical cannabis since its reclassification in November 2018, and that it was likely this would remain the case until prescribers have access to more evidence and information about what they should prescribe.

“Prescribers who wish to prescribe [medical cannabis] just don’t know which the right product is for that person and until there are products that are more familiar, the situation may well still remain.

“Aside from all of the issues around cost — because these are not cheap products — if you look at some of the products that are available in other countries, even though they claim they are manufactured to [good manufacturing practice] standards, they should be more reproducible in terms of their composition.

“The way in which they are packaged and supplied at the moment is unhelpful for prescribers.”

The National Institute for Health and Care Excellence is due to publish guidance on medical cannabis in October 2019.

Knaggs also drew attention to the recent opening of private cannabis clinics, which he said create other issues, such as equity.

“A couple of weeks ago, the person who had the first cannabis prescription decided that they had exhausted their savings and was openly going to grow their own illegally because they couldn’t continue to afford the private prescriptions.

“There are so many issues that this is creating.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206487

Readers' comments (2)

  • This is a presposterous intervention from a man who clearly doesn't know what he is talking about. His assertions about evidence of benefit and so-called "serious harms" are nonsense and don't properly reflect the very large amount fo evidence that is available. Cannabis provides very substantial therapeutic benefit to millions of people worldwide and there is little credible evidence for any harm let alone serious harm which is non-existent in medical use.

    It says everything about the establishment's attitude to the the use of cannabis as medicine that a body concerned with the 'misuse of drugs' is involved at all. They have no business poking their noses in where they are not needed.

    Unsuitable or offensive? Report this comment

  • This article requires a comment. We have a great deal of knowledge and experience of the safety profile of cannabis which simply does not support the extreme claims made.

    Cannabis is widely used recreationally, millions of people do so, often from a young age. Many people continue the recreational use over many years, indeed decades is not uncommon. This has been happening for an extended period of decades.

    Recreational use involves high doses of the most potent varieties of cannabis, taken entirely without supervision or oversight. The supplies used are ungraded and vary greatly in terms of composition and purity. and are consumed in the most hazardous way possible by smoking, often mixed with tobacco.

    All of this amounts to "soak testing" cannabis in a way most likely to show problems and to cause harm.

    Despite all of this, the problems created by this extremely widespread and heavy use of cannabis are relatively minor.

    Medicinal use is nothing like recreational use. We are talking about use under the direction of a doctor, at much lower doses and of cannabis with a known profile and a high standard of purity. To claim:
    “the evidence for benefit is very small but the evidence for … more serious harms, is significantly higher”.
    “If you look at the number needed to treat, you need to treat between 20 to 25 people for 1 person to have good pain relief, but you only need to treat 6 patients for 1 to experience harm,”

    Is clearly ridiculous.

    Unsuitable or offensive? Report this comment

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