Cannabis oil – is it a pain control option for mesothelioma sufferers?

On 1 November 2018, the UK legitimised the use of cannabis oil and cannabis containing products for medicinal purposes. The news came on a background of what has seemed to be a re-branding of cannabis, with a number of countries around the world decriminalising and legalising it. Only a few weeks before the announcement was made, I attended the Mesotheliomas UK Patient and Carer Day at the National Arboretum and heard sufferers of mesothelioma explain how they had started using cannabis oil to help control their pain, when other prescription medicines had not helped them. One lady told those at the day about the awful pain she had been in, how it had been almost debilitating and that whilst she wanted to enjoy her life for as long as she was here, she was struggling to do so and live well and enjoy life because of the pain. She started smoking cannabis oil and said that she felt like a different person. It had reduced her pain and she felt much more able to cope with her illness and get her life, doing the things she wanted to do. So the question arises, whether cannabis oil is now a realistic option for mesothelioma sufferers. How easy will it be to obtain and how can we combat the stigma associated with cannabis to ensure that those who have a need feel comfortable in asking and taking medication?

What is medical cannabis?

The NHS website says that medical cannabis is a broad term for any sort of cannabis based medicine used to relieve symptoms. There appears to be a number of products, which include:

• Epidiolex – a highly purified liquid containing CBD (cannabinol). This is said to be a chemical which has many medical benefits, but it won’t get you “high” because it doesn’t contain THC (tetrahydrocannabinol). The website says it is not yet licenced in the UK but is currently going through the licensing system. This is mainly used for epilepsy sufferers.
• Nabilone – a medicine which is taken as a capsule. It has been developed to act in a similar way to THC and is often described as a man-made form of cannabis. It has been licenced in the UK and been proven to have a medical benefit. This is mainly used for people having chemotherapy, who go through periods where they are feeling sick.
• Nabiximols (Sativex) – a cannabis based medicine which is sprayed into the mouth. It is available on the NHS, but to a limited extent as NICE do not consider it to be cost effective. This drug is mainly used for MS sufferers.

Is there any evidence that medicinal cannabis works?

There has been a lot of emerging clinical data and also significant amount of anecdotal evidence which suggests that medicinal cannabis is helping people with a range of conditions.

As is clear from the above, the NHS obviously envisages that medical cannabis will mainly be prescribed to, and benefit, those suffering with epilepsy, MS, and people undergoing chemotherapy.

There is also a recent article in the British Medical Journal which suggested that cannabis could be useful for the treatment of chronic pain, spasticity, as well as nausea and vomiting due to chemotherapy as well as drug-resistant forms of epilepsy, as well as other conditions.

There have been some recent high profile campaigns by parents of severely epileptic children which has led to widespread public sympathy and is probably the background to the government’s decision to legalise cannabis for medicinal purposes.

Billy Carldell, a 12 year old epilepsy sufferer, was experiencing awful seizures and had his cannabinoid confiscated. This led to an absolute fervour as there was clearly no sensible rationale why this should be the case when all of the traditional medical products that Billy had been prescribed, had not helped him.

In July 2018, Professor Mike Barnes, an expert in medicinal cannabis, secured an emergency licence for a drug for Alfie Dinley, another young epilepsy sufferer, whose epilepsy had responded to full extract cannabis oil, containing CBD and THC. The professor said that patients like Alfie who were suffering from epilepsy and other serious neurological and psychiatric conditions, as well as those suffering for chronic pain, who have been crying out for the kind of life changing treatment which medicinal cannabis products can offer. Indeed, only last month, in March 2019, he opened the country’s first private centre specialising in the medical cannabis treatments in the UK. The Beeches is based in Cheadle, in Cheshire and the professor sees it as an important step forward for healthcare in the country, bringing the UK into line with other countries when it comes to pain control management.

Can mesothelioma sufferers access medicinal cannabis?

The scheduling of cannabis under the Misuse of Drugs Act 2001 has been changed following the announcement of the Home Secretary, Sajid Javid back last July. Cannabis was previously in schedule 1 of the Act, which meant that it was labelled as having “no medical value”. It has now been moved to schedule 2 meaning it has been accepted to have a medical value, which will in itself make research into its uses easier.

Only certain clinicians will be able to prescribe medical cannabis. There are 8,000 specialist doctors on the General Medical Council register, who will be able to make that decision. However, the rules are strict, in that they will only be able to prescribe it to patients who have an “unmet clinical need”, i.e. that they have a condition which cannot be helped by licenced products. Therefore, in theory, mesothelioma sufferers who have tried other forms of pain relief, common drugs being oramorph and the like, could speak to a specialist about whether medical cannabis could be an option for them.

However, I wonder whether in reality it will be this easy. At this stage, there has not been that much research into the benefits of using medicinal cannabis and there are few products available. It is unlikely that many specialists will have had much guidance or training on prescribing the products and understandably, many may worry about what will happen and what support will be available both to them and the patients if something went wrong.

What’s to lose?

Legalisation of cannabis products for medical use may seem strange when the UK is facing a war on drugs. However, the changes to the law are extremely minor. We are a long way from countries such as Spain, who have allowed the consumption and possession of cannabis for personal use and indeed, even allow people to grow their own. Canada is the second country to legalise it, with the US, parts of Australia and India allowing some use for medical purposes.

The government in this country have made it clear that it is a medical, not a political matter. It is extremely unlikely that the use of cannabis will be legalised for recreational use. Only specific products are available to be prescribed, yet it is not yet clear the extent to which all of these products work. When you are desperate, you will try everything and surely patients should be encouraged to seek the advice of their doctor and have products prescribe, rather than turning to the black market and buying products online which may contain anything. Mesothelioma patients should not be embarrassed to ask their consultants about it. We need to encourage those conversations and where everything else has failed, and there is an unmet clinical need, then cannabis may have a role to play in pain control for mesothelioma sufferers.