Possible
transfer from Schedule 1 to Schedule 2
7.6 According to the
Home Office (p 150), cannabis could be transferred from Schedule
1 to Schedule 2 by statutory instrument, subject to negative
resolution in Parliament. The ACMD would have to be consulted
first. According to the Minister (Q 676), under the 1961
UN Convention, rescheduling cannabis itself and cannabis
resin would not require international agreement; but, under the
1971 Convention, rescheduling cannabinol and its derivatives other
than dronabinol would require prior amendment of the Schedules
to the Convention through the WHO and the UN Commission on Narcotic
Drugs, as happened in the case of dronabinol in 1995.
7.7 Rescheduling would
allow doctors to prescribe; but the Home Office say, "Our
understanding is that the ability of doctors to prescribe cannabis
would be hampered in practice if a cannabis-based medicine had
not been granted a marketing authorisation by the MCA". The
Minister said that there were "compelling policy reasons"
for requiring an MCA licence first (Q 676). When asked to
explain the practical difficulties, he referred to the extra burden
of responsibility which a doctor takes on by prescribing an unlicensed
medicine (Q 679); he queried the wisdom of permitting prescription
without proof of safety and quality (Q 680); and he noted
that the ACMD had not called for change (Q 688).
7.8 Rescheduling would
also allow doctors and pharmacists to manufacture and supply (Q
680); anyone else, including a pharmaceutical company, would require
a Home Office licence. It would not in itself disapply section
8 of the Misuse of Drugs Act, which makes it an offence to allow
cannabis to be smoked on premises; but this could be done by secondary
legislation (Q 684).
7.9 So the Government
could reschedule cannabis; the next question is, whether
they should. Dr Lambert says, "Many patients are already
illegally using cannabis...Their needs must be addressed whilst
formal studies are undertaken"[25].
IDMU finds the present position "inhumane", and "unjustifiable
both on moral and on public health grounds" (p 229).
Dr Pertwee says (p 68), "A strong case can be made
on the grounds of common sense and compassion for allowing doctors
to prescribe...(oral) cannabis now for serious symptoms including
muscle spasms"; but he admits that it will take better evidence
to persuade the Department of Health (Q 263; see also paragraph
7.15 below).
7.10 Dr Robson described
the present position as an "affront to humanity" (Q 460).
He called for "compassionate reefers" for AIDS and cancer
patients (p 118), and possibly for patients with non-terminal
conditions who might feel that the increased risk of cancer was
worth taking (Q 469). He suggested that patients might be made
to confirm in writing that the doctor had explained the risks;
and that, if it were felt necessary, the number of doctors entitled
to prescribe cannabis could be limited, as in the case of diamorphine
(heroin) or cocaine prescribed for addicts under the Misuse of
Drugs (Supply to Addicts) Regulations 1997 (Q 471). He added
that research into synthetic cannabinoids might soon make herbal
cannabis obsolete; but, in the mean time, "it just is not
a dangerous enough drug for me to want to ban it" (Q 472).
7.11 The ACT want "medical
preparations of natural cannabis...to be made available on a doctor's
prescription while research is going ahead" (p 28),
by moving cannabis from Schedule 1 to Schedule 2 (Q 133).
They argue that "we know now that cannabis can be effective
and is safe enough to be prescribed by a doctor...and there are
people who need treatment now". Similarly, six of our witnesses,
all users of cannabis for medical purposes themselves, want cannabis
to be prescribable or otherwise legalised for medical use. 195
out of 200 respondents to the Disability Now survey, of
whom 192 were disabled and 134 had taken cannabis for medical
purposes, wanted such use to be legalised.
7.12 The London Medical
Marijuana Support Group (p 271) consider the issue to be
one of patients' rights: "Please do not continue to make
sick people criminals". They call for either rescheduling,
or a new system involving registration of patients. They would
solve the problem of supply by allowing patients to grow their
own, or by setting up co-operatives, or by permitting commercial
cultivation. They argue that different users get benefit from
different preparations; so they do not want a standardised preparation—though
this would be better than nothing.
7.13 If the law cannot
be changed, it could in theory be applied with flexibility. IDMU
suggest "directives to the CPS on criteria to use when deciding
whether a prosecution of a medical cannabis user is in the public
interest" (p 225). According to the Home Office, however,
systematic non-enforcement would be "quite unacceptable"
(Q 671).
7.14 Though some witnesses
to this Committee favour immediate transfer from Schedule 1 to
Schedule 2, others are against it. Professor Radda insisted that
anecdotal evidence, however large in volume, was not sufficient
reason for rescheduling (Q 657). Sir William Asscher considers
that immediate rescheduling would actually threaten proper trials,
such as those proposed by his working party (see Chapter 5), by
encouraging patients to use cannabis in an uncontrolled way rather
than enrolling for the trial and risking receiving a placebo (Q
808).
7.15 The Multiple Sclerosis
Society want sufferers to be able to make "informed choice
about therapeutic agents"; therefore they would not support
prescription of cannabis for MS in advance of proper trials (p 90,
Q 368). The Royal Society say that, pending proper trials,
"There is no persuasive case for the non-experimental medical
use of cannabis"; and they are against smoking (p 295).
The Royal Pharmaceutical Society take the same line (p 289);
so does Professor Strang, who would be worried if cannabis
were given "some easy track" (Q 249); so does Edward
Jurith, on sabbatical in Manchester from the post of General Counsel
to the White House Office of National Drug Control Policy (p 265).
The Christian Institute agree: "The rules must remain the
same for all substances...Rescheduling cannabis would declare
that cannabis is suitable for medical use. The studies have not
been done to demonstrate this" (p 207). They add that
permitting cannabis to be smoked "would profoundly damage
current health promotion attempts to dissuade smoking". They
suggest that other steps might be taken to help MS sufferers who
are resorting to cannabis. Dr Pertwee considers that permitting
prescription of cannabis could not be justified until both nabilone
and dronabinol had been tried and failed (Q 314).
7.16 The BMA report
recommends, "The WHO should advise the UN Commission on Narcotic
Drugs to reschedule certain cannabinoids under the UN Convention
on Psychotropic Substances, as in the case of dronabinol [which
was rescheduled in 1995]. In response the Home Office should alter
the Misuse of Drugs Act accordingly." Alternatively, "The
Government should consider changing the Misuse of Drugs Act to
allow the prescription of cannabinoids to patients with particular
medical conditions that are not adequately controlled by existing
treatments". On the other hand, David Nutt, Professor of
Psychopharmacology at the University of Bristol[26],
considers that the availability of nabilone, which may be prescribed
on an unlicensed basis for any of the conditions identified by
the BMA, makes it unnecessary to change the law (p 280).
7.17 The Royal Pharmaceutical
Society caution that, if unlicensed use of cannabinoids becomes
more common (as the BMA think it might, following their report—Q 83),
there should be "full consultation between the medical and
pharmacy professions" (p 290). They urge the Government
to consider moving all cannabinoids from Schedule 1 to Schedule 2.
Research
7.18 As noted in Chapter
3, cannabinoid pharmacology is currently a lively field of research.
However, until Dr Guy's initiative, no new cannabis-based medicines
were in commercial clinical development (Wall Q 134). As
to why this should be so, most of our witnesses point to the "stigma"
of working with a "disreputable" substance and a Schedule
1 controlled drug (e.g. Austin Mitchell MP Q 132, Pertwee Q 317,
Robson Q 482). Others point to the likelihood that a non-synthetic
cannabis-based medicine would be cheap and therefore unprofitable,
and the markets for it small (RPharmSoc p 289; Lader QQ 7,
17)—though Professor Ashton and the BMA believe that the
global market is potentially large (Q 57). Dr Pertwee believes
that drug companies are very interested in the possibility of
cannabinoids which avoid psychotropic effects by acting only on
the CB2 receptor (Q 281); they are "dying to get in
there, but they do not know what to do" (Q 295).
7.19 Dr Notcutt believes
that what puts companies off research involving a Schedule 1 drug
is not the stigma, but the "sheer difficulty" (Q 414).
The principal additional difficulty is the requirement to obtain
a licence from the Home Office (see Box 8). If cannabis were moved
to Schedule 2 to the Regulations, research licences would
no longer be required (Q 677).
