Medical cannabis has been legal in Australia since 2016 with almost 20,000 legal patient approvals.
The law was introduced in Australia in February 2016 to establish a regime authorising the cultivation and production of medicinal cannabis. This allows for a supply of medicinal cannabis products to be available for therapeutic purposes and furthermore to facilitate scientific research in the area. Recreational cannabis remains illegal.
The United Kingdom made medical cannabis legal in November 2018. This was a moment that was hailed as a landmark victory for the British medical industry, with scientists, researchers and patients alike welcoming the revision. However, getting access to medical cannabis has not been an easy feat for UK patients, with most prescriptions being provided through private practices.
As cultivation and storage of cannabis is not permitted in the UK, each prescription is ordered on a name-patient basis from other countries, meaning patients can be waiting months at a time for their prescription.
Paul Mavor, an Australian and UK pharmacist whose company, Health House, was granted the first medicinal cannabis import license in Australia.
Mavor spoke with Medical Cannabis Network about speeding up access to medical cannabis prescriptions for patients and about knowledge sharing between the United Kingdom and Australia.
Australia and United Kingdom: knowledge sharing
Australia has come a long way since Mavor’s first import – he said: “We imported the first shipment into Australia and it was also one of the first global shipments anywhere. The Australian government legalised medical cannabis previously and allowed us to import the medicine in bulk – which is very different to the UK, as in the UK it is on a name-patient basis.
“While that status quo is maintained some of the prices of medical cannabis are going to be very, very expensive.
“Health Canada takes 30 working days to process a prescription, which, sometimes, can end up taking up to two months once you take into account delays, weekends and public holidays. We have already seen doctors writing prescriptions and the patients not receiving medication until six weeks later. Importing one prescription instead of 100 or 1000 makes the cost about ten times higher than it should be.
“When we made our first import, we had support of the Australian government and shook the hands of the of the customs officers when we picked up the parcel – it was the start of a new era.”
Mavor noted that education and advocacy are vital when it comes to knowledge sharing.
He said: “Education for prescribers is extremely important to start the ball rolling – with health professionals educating other health professionals. It has worked in Australia as a lot of people have received that education and been able to understand the research, the dosing and the endocannabinoid system.
“A lot of the prescribers were trained ten and 20 years ago and have never been taught about the endocannabinoid system and prescribing cannabis – it is a very new area of science that is only just being taught in medical schools. This is changing for younger graduates however but there is a lot more work to be done. It is ongoing thing and there is a lot of research happening which is changing it on a daily basis.”
He continued: “Attitudes around medical cannabis need to change – it is not an alternative medicine, it is a mainstream drug that has been used for a very long time. Cannabis is another tool in the box and we definitely need to do more research – but there is enough evidence there to roll this out for a certain cohort of patients.
“We set up Medical Cannabis Research Australia and we have some amazing people involved in the project; it’s about education. So, we helped set up a group called Medical Choices UK because we wanted to establish and get things rolling in the UK and help with advocacy moving forward.
“Advocacy, education and research are the three main pillars of our organisation.
“It is very important to promote the research and the science, however, we also have to be so careful not to overstate benefits, as there are side effects and it may not be the best drug for certain conditions.”
Quick and easy access to medical cannabis is not an option for UK patients, with many waiting up to six weeks or longer to receive their medication.
Mavor said: “When we started prescribing here in Australia, like the UK, patient access was very difficult. The process was a two month wait with a lot of hoops and hurdles. These were medical patients that were often chronically ill and there were few prescribers.
“Unfortunately, what the regulators did was cut and paste a lot of the regulation around amphetamines when there was too much prescribing in that area. Of course, there was no prescribing in the area of medical cannabis – so it just didn’t work.
“In Australia we had palliative care patients who we could have prescribed the next day but their prescription was only approved months later.
“Within that time the patient passed away after a few days, meaning they had no access to medicine during that difficult time. Thankfully, now we have managed to get the time down from around two months to less than a day. Our fastest approval came in at 3 minutes. Instead of a hefty array of paperwork there is now a one page online form which is approved by a delegate rather than a committee.”
“We have GPs allowed to prescribe and more clinics are being set up that patients can be referred to. We had 300 in the first year and are now on track for 20,000 patients.”
Mavor said that it is not always the politicians that are getting in the way of speedy access to medicine.
He said: “The United Kingdom can advance patient access through negotiation, and advocacy through medical cannabis research.
“This is why it is important to have education as well as advocacy. It is important to have that conversation with the regulators and make sure there is balance of patients receiving medicine in a timely manner.
“In Australia we had a two-tier system, federal approval then state-by-state approval. It is still not perfect, but we have got rid of most of the state approvals and we have streamlined the federal approval from being a number of forms to becoming a one-page online form that the doctors can fill out. They used to have to assess each case but now, as long as it falls within the guidelines, it can be approved a lot faster.”
Cannabis in the UK is accessed through a private prescription – it has not yet been subsidised. However, many places such as the Czech Republic are starting to see patients receive subsidies through various private health funds.
Mavor said that: “The NHS trust may find that it is cash flow positive to pay for medical cannabis in cases such as treatment-resistant epilepsy, for example, because if it is keeping patients out of hospital and healthy than that is actually saving money as well as alleviating the patients suffering and help them live a healthier life at the same time.
“There is a lot of blame being apportioned to politicians, big pharma the medical community but it is none of those people holding it back – the conversation needs to be with the regulators the guidelines of specialists-only prescribing.
“Having medical cannabis imported on a name-patient basis and not being able to store any stock in the country is really increasing suffering by not allowing access in a timely manner. It is essentially a prohibition-style access scheme because there is so many hurdles.
“Both of these things need to change. That is not to say there will be bulk prescribing, but it means people can access it so much quicker. This is especially important for palliative care because there is really good evidence for end-of-life care and for nausea induced by chemotherapy for example, as well as drug resistant epilepsy – some of those patients can’t wait six weeks.
“There is hope – it just needs advocacy. Medical cannabis is a valid treatment option.”