Chronic pain, chemotherapy-induced nausea, multiple sclerosis spasticity symptoms and epilepsy. All, and more, put physical pain on patients and pressure on the NHS. An illness like chronic pain debilitates up to 28 million adults in the UK and individuals with epilepsy commonly lose control over their seizures. There is one thing that links all these together: medical cannabis can help treat them. So why aren’t doctors in the UK all over it?
In brief, there are 400 chemicals inside a cannabis plant and 80 of those are found solely in the plant, called cannabinoids. Most cannabis that is used for medicine is made from CBD, CBG, CNB, and THC.
Focusing on the UK and the National Health Service, medical cannabis was actually approved for use in November 2018. However, this didn’t mean prescriptions of cannabis swarmed patient treatment plans, in fact, only 12 prescriptions of medical cannabis have been made within the NHS. Meanwhile a survey completed by the Centre for Medical Cannabis found 1.4 million people currently use illicit cannabis for medical problems.
It took pressure from cases such as Alfie Dingley - a young boy with a rare autoimmune epilepsy whose only successful treatment was cannabis medicines - for the UK to legalise products like CBD (cannabidoil which is a cannabinoid extract from the cannabis plant). This begs the question, if the treatment of medical cannabis was so urgently effective for a case of epilepsy that a new law was passed, then why aren’t more prescriptions made each year?
This is where the ethical debate comes in. You will find the positions of ‘for’ and ‘against’ the use of medical cannabis are polarised. Either medical cannabis is the new ‘wonder drug’ that cures all or it’s a sure death sentence for anyone who uses it. Since no one can meet half-way and accept its benefits and downsides (like many other widespread pharmaceuticals), properly conducted research isn’t happening, making both arguments stand on weaker and less scientific ground. For example, different trials are using different cannabinoids (i.e. pharmaceutical cannabinoids rather than plant-derived medical cannabis) and different potencies or dosages, so it becomes impossible to compare results to form a standardised and accepted ‘safe’ dosage for medical cannabis.
On one hand, there is significant evidence that points towards cannabis or cannabinoids being effective in treatment for chronic pain, epilepsy, multiple sclerosis spasticity symptoms, etc. In certain trials, the placebo - a ‘fake’ treatment given in a blind trial to remove the psychological effect that introduces bias into results - proved that using cannabis as medicine for treatments of epilepsy significantly improved symptoms and the patient’s quality of life. For chronic illnesses there are very few effective treatment alternatives, thus the patient demand for medical cannabis is high. Unfortunately, this limited placebo-controlled evidence prevents doctors from having solid evidence-based knowledge on when and how to prescribe it.
In addition to its investigated health benefits, studies have shown that it is impossible to overdose on CBD, contrary to popular belief. This is because our brain stem does not contain enough endocannabinoids for overdose to occur. Yet, for other recreational drugs like heroin, opioid receptors are abundant in the brain so you can overdose on them, leading to this misconception of cannabis overdoses.
On the other hand, due to the extremities of individuals' symptoms from chronic illnesses, many are using cannabis from illicit resources. The lack of physician education in place and an evidence base must be resolved to minimise the potential harm illicit cannabis may have. A key problem highlighted is that the healthcare system has legalised medical cannabis, but has largely left individuals to independently access and use them, which possibly undermines any promised ‘duty of care’ to these vulnerable patients.
Expectedly, concerns over side effects of medical cannabis usage have been raised. When used as a pain relief, could this be a gateway drug to more dangerous drugs? As far as addiction goes, according to a study, only 9% of people who use cannabis long-term become addicted. It has also been shown that people can go through withdrawal once quitting cannabis, as well as chronic cannabis usage being able to ‘rewire’ parts of your brain and potentially causing psychosis, increasing anxiety and paranoia, or exacerbating symptoms of schizophrenia. For children and adolescents, the balance between treatment and ethics becomes even more complex. As a psychoactive drug, the younger the individual the higher the risk for cannabis dependence or long-term side effects. Even so, we have established the lack of evidence based scientific knowledge of the full effect of cannabis and CBD use, so arguments from both sides, to reiterate, require more research.
In conclusion, the UK’s current legislation on medical cannabis must be reviewed to maintain good medical practice and move with the shifting attitudes of the general public. A framework needs to be devised in order to prioritise patient safety and the mentioned ethical concerns. For now, to uphold well-established principles of nonmaleficence and beneficence, medical cannabis is only recommended for those conditions with the strongest evidence base.
Bibliography
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Collins, J. (2019). Ethics and medical marijuana. Dr Jim Collins. Retrieved June 29, 2021, from http://www.drjimcollins.com/ethics-and-medical-marijuana/
Couch, D. (2020, May 11). Left behind: The scale of illegal cannabis use for medicinal intent in the UK. The Centre for Medical Cannabis. Retrieved June 29, 2021, from https://thecmcuk.org/left-behind-the-scale-of-illegal-cannabis-use-for-medicinal-intent-in-the-uk
Deacon, H. (n.d.). Why I campaign for children like my son Alfie Dingley to be able to get medical cannabis. BMJ, 365(8197).
Glickman, A., & Sisti, D. (2019, December 18). Prescribing medical cannabis: ethical considerations for primary care providers. Journal of Medical Ethics, 46, 227-230. https://jme.bmj.com/content/46/4/227.info
Schlag, A., Baldwin, D., Barnes, M., Bazire, S., Coathup, R., Curran, H., McShane, R., Phillips, L., Singh, I., & Nutt, D. (2020, June 10). Medical cannabis in the UK: From principle to practice. Journal of Psychopharmacology, 34(9), 931-937. https://doi.org/10.1177/0269881120926677
