“We’ve had a change in the laws,” says Gavin Sathianathan. “But that’s a necessary, not a sufficient, condition towards people getting access to cannabis medicines.”
More and more people are using cannabis as a medicine, both in the UK and abroad; and in the UK the rules have changed to allow doctors to prescribe it in certain circumstances. But there are challenges unique to cannabis that make it harder to research, market and prescribe: the usual model of getting a drug to patients, of clinical trials and regulation, hits hurdles with cannabis that you don’t see elsewhere.
Sathianathan is the CEO of a botanical medicines firm, Alta Flora, which makes cannabis-based drugs, among others. He is one of a new breed of cannabis producer who are trying to make the drug scientifically respectable, to put its medical use on an evidence-based foundation like that of other medicines. At the moment, it is often either seen by large parts of the medical establishment as medically useless, or held up by ageing hippies as a quasi-mystical panacea.
“Cannabis is complex, pharmacologically,” he says. “Traditionally, pharmaceuticals tend to be single molecules with a single target. Cannabis is a treasure chest of medicines”.
That makes it harder to study, says Harry Sumnall, Professor in Substance Use at Liverpool John Moores University. “There are some products that are extracts such as Sativex and Epidiolex.” They are drugs that reduce spasticity in multiple sclerosis patients, and reduce the frequency of epileptic seizures respectively. Sativex is already licensed. Epidiolex is approved by the FDA for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, and recently won a positive recommendation for marketing approval from a European Medicines Agency (EMA) panel. But they are specific chemicals, extracted and purified, and tested like any other drug.
Where it gets complex is with “whole-plant” herbal products: flowers, or largely unrefined extracts such as oils. Many people who use, and derive benefit from, cannabis medicines use it in this form. “The plant contains hundreds of cannabinoids and other chemicals,” says Sumnall. “You see this end result, but what actually produced it? Was it the THC, the CBD, the whole product? Translating it to what your GP will prescribe is very difficult”. And the plants and their derivatives are not of standardised strength. “You can’t say ‘take two tablets a day and you’ll be fine’, because it’s so complex”.
Instead, argue some producers and scientists – David Nutt, the former chairman of the government’s Advisory Council on the Misuse of Drugs, among them – we need to find a new regulatory framework for cannabis products, and new ways of testing them.