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1.16 pm

The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng): My hon. Friend the Member for Great Grimsby (Mr. Mitchell) brings to the debate a passionate commitment and considerable knowledge of his subject. For that, the House is grateful. The subject provokes strong views on both sides. The issues surrounding the prescription of cannabis are complex and not capable of easy or rapid resolution, as I know my hon. Friend will recognise.

The issues are of obvious importance to our society, as we grapple with the problem of the abuse of drugs, and as we seek to alleviate suffering and distress, not least for groups of people, some of whom my hon. Friend mentioned, for whom medical science does not always have a great deal to offer. We are, of course, sympathetic to their concerns and their plight.

My remarks are not meant to be defensive. They are meant to be a statement of profound principle. We should not accept a lesser standard of evidence in the case of cannabis because of the pressures, to which my hon. Friend has contributed--properly, as he sees it--on behalf of people who are convinced of its therapeutic value. Society requires us to determine the matter on the basis of the evidence. That position is endorsed by the Multiple Sclerosis Society, which considers that, in common with all other drugs for that lifelong disease, rigorous scientific trials are needed before licensing. The Government have profound sympathy for that position.

It is true that cannabis could be prescribed until 1973. It was rarely used and, when it was, it was used mainly for its sedative qualities. Advice at the time from the World Health Organisation was that cannabis was no

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more effective than any other available drug in treating the conditions for which it was used, so its use was stopped. That was not a panic response, but the result of a World Health Organisation initiative.

During the past quarter of a century, there have been considerable changes in the way in which we view prescription drugs. I am sure that all hon. Members will agree that we now adopt a much more rigorous attitude to drug safety and effectiveness--it is right that we should do so. That means that all drugs that are currently available on prescription have undergone a stringent review of their safety, efficacy and quality.

The Government believe that the case has not yet been proven for the therapeutic use of cannabis. Until a strong, sound, research-based case is made, it is not possible for cannabis or any of its constituents to be prescribed for use by people suffering from multiple sclerosis or any other condition. To allow any substance--not just cannabis--to be prescribed without adequate proof of its effectiveness and safety would be a highly irresponsible and retrograde step. It is not one which the Government are prepared to take.

The good-quality research evidence needed to make the case for the use of cannabis is not currently available. The British Medical Association recognised that fact in its recent publication "Therapeutic uses of cannabis". Much of the existing research evidence on the use of cannabis is flawed, and is recognised as such. The studies examined by the BMA in its extensive piece of research--for which we owe it a debt of gratitude--were methodologically unsound and all too frequently involved very small numbers of subjects. Therefore, no firm conclusions could be reached.

In fact, the BMA report recognises that cannabis is not the risk-free option that many people suppose. That is particularly true if it is smoked. Cannabis smoke contains all the toxic elements of tobacco smoke, apart from nicotine. We must take account of the potential risks associated with short and long-term use of cannabis in reaching any decisions about its therapeutic use. Short-term risks include impairment of concentration and manual dexterity and short-term memory loss.

In the long term, people who smoke cannabis--I recognise the distinction that my hon. Friend made between smoking cannabis and taking it in various other ways--are more likely to develop respiratory diseases such as bronchitis and lung cancer. Nor is the eating of cannabis free from danger. Cannabis taken orally has a much slower absorption rate, which can vary greatly from person to person. That means that people can be affected for longer than they think, experiencing problems with their motor skills and concentration long after they believed that the effects had ceased.

Given the nature of those risks, the BMA has concluded that cannabis is unsuitable for therapeutic use and that future research should concentrate on exploring the properties of cannabinoids, which are the unique constituents of cannabis. Cannabinoids are known to latch on to receptors in various sites in the brain. At present, we do not fully understand which cannabinoid attaches to

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what receptor in the brain and what happens when that occurs. We cannot be certain that all the effects are beneficial until we have the results of further research.

Dr. Peter Brand (Isle of Wight): Will the Minister give way?

Mr. Boateng: No, not at the moment. The Government do not wish to stand in the way of sound research in this area--especially research into the identification of cannabinoids and the exploration of their use as a medicine. Department of Health officials, led by the chief medical officer, will meet BMA representatives to talk about those issues.

My hon. Friend has said that there are those who contend that the misuse of drugs legislation makes research difficult and that cannabis should therefore be rescheduled under the Misuse of Drugs Regulations 1985 from schedule 1 to schedule 2. It will come as no surprise to my hon. Friend to learn that the Government do not accept that contention. In fact, the Home Office has granted licences to 22 research initiatives involving cannabis, 19 of which are still in force. Three are concerned directly with medical research involving patients. No applications have been rejected in the recent past, and I know that the relevant Home Office officials are happy to give advice to researchers, drug companies and other interested parties, as is the Medicines Control Agency.

In fact, the Home Office has already met one of the members of the delegation organised by the Alliance for Cannabis Therapeutics, which I was glad to receive and which included my hon. Friends the Members for Great Grimsby and for Pendle (Mr. Prentice). I am sorry if the delegation was disappointed by its reception--my hon. Friend could not have expected me to roll over and have my tummy tickled. That is not the way of the world. As a result of that meeting, a member of the delegation has at least had the opportunity to meet Home Office officials to examine the way forward.

There is no reason why it is not possible to undertake sensible size clinical trials within the current legislation. If there is sufficient demand for them, that is what will happen. However, we must ensure that we proceed on the basis of scientific evidence, recognising the proper role of the Home Office and the Medicines Control Agency in this area. A stringent review of safety, efficacy and quality is vital if we are to proceed.

Mr. Paul Flynn (Newport, West): Will the Minister give way?

Mr. Boateng: I shall give way to my hon. Friend, knowing of his involvement in this area and of the very useful debate on this subject that he initiated in 1995.

Mr. Flynn: Sadly, today's answer is exactly the same as that which I received in 1995. Will the Minister explain why he will not agree with my hon. Friend the Member for Great Grimsby (Mr. Mitchell) that cannabis should be returned to its original schedule where the relevant research is far more likely to take place? It was moved only because it was deemed to have no therapeutic value. However, the British Medical Association says that cannabis has therapeutic value, as does the Medical

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Research Council, which wrote to me two years ago saying that it did not believe further research was necessary because the therapeutic value of cannabis had been proved.

Mr. Boateng: This time my hon. Friend at least has the comfort of hearing the same answer from his side. We are not able or prepared to turn back the clock. We wholly support a philosophy and an approach to the development of all treatments that is based on sound clinical research evidence.

Dr. Brand rose--

Mr. Boateng: I do not intend to give way to the hon. Gentleman.

When that evidence exists, we have the basis for moving forward; until it exists, it is not possible to do so.

I hope that the discussions currently taking place between the Department of Health, the BMA and the Home Office--which resulted from the initiative displayed by my hon. Friend in leading a delegation to the Department in December--will lead to the discovery of sound empirical evidence upon which it will be possible to proceed.

We are not prepared to accept lesser standards in relation to cannabis for the relief of suffering than would be applied to any other drug. That is the duty that we have to patients. It is the duty that we have to those who are suffering and it is the duty that we have to society. It is a duty from which we do not intend to flinch.

My hon. Friend knows that my door is always open to him to ensure that he is satisfied that these matters are being properly explored, but I must tell him that we are unable to accede to the proposition that he has--

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