HC Deb 14 January 1998 vol 304 cc317-23

1 pm

Mr. Austin Mitchell (Great Grimsby)

I am grateful for the opportunity to draw attention in this short debate to a change that drastically needs making—allowing the prescription of cannabis for certain specified medical conditions. This is not part of any general argument about the decriminalisation of cannabis—it is a unique subject, although it has a bearing on that argument. To allow cannabis to be made available on prescription would effectively make the law more rational and enforceable in respect of other uses.

Today, I am discussing the case for moving cannabis from schedule 1 to schedule 2 of the Misuse of Drugs Regulations 1985. It will still be illegal, but if it is moved to schedule 2, research into it can be carried out; and it will be available on prescription to named patients.

It is quite illogical not to allow cannabis to be provided in this fashion. Indeed, until 1971 it was available on prescription, but it was then moved from schedule 2 to schedule 1, which comprises drugs with no therapeutic value. Strangely, heroin, cocaine and two synthetic cannabinoids have been left in schedule 2. If the Minister sees any logic in that, I hope that he will explain what it is.

I cannot see why Home Office licences are required for research into cannabis but not for research into heroin. Ever since 1971, the move to schedule 1 has been used as an excuse for doing nothing about cannabis as a form of treatment. In effect, there has been a total block on research.

Most research is done by the drug companies because it is so expensive, but what drug company will put money into research into an illegal substance that cannot be used for prescription? Who then will do the research, when applications to do it are shuffled around, as they are now, between the Department of Health and the Home Office? Licences are incredibly difficult to obtain, and the Home Office in particular seems to drag its feet.

Who will develop a standardised product of the type we need, if such research is not possible? We need research to discover which part of the complex chemistry of cannabis can be used for therapeutic purposes, but that research is just not being done. We need research into ways of taking cannabis for treatment purposes. I understand that it used to be available in tincture form. The Dutch have developed preparations of cannabis that can be taken orally or by inhaler. I am not asking that people suffering from medical conditions be allowed to smoke cannabis, but we need research into a form of it that will dissociate treatment by the drug from its leisure uses.

All this work is being held up by the decision in 1971 to shift cannabis to schedule 1. Meanwhile, the situation has been changing rapidly, invalidating the 1971 decision in the process. First, word has spread among the thousands of multiple sclerosis sufferers that cannabis is of value in treating their condition. They have found relief from pain, greater bladder control, and more control of spasms. The Alliance for Cannabis Therapy, which was formed to campaign on the issue and which has done a magnificent job, has received more than 3,000 letters from MS sufferers describing the value of cannabis in their treatment. But they have been driven into illegality by their need for this treatment.

I should like to quote some of the moving letters that have been received—I wish that the Minister would go through them. Here is one written in 1996: I have dreadful spasms in my legs and can take pills like diazepam without any effect. Half a cigarette a day doctored with cannabis stops the spasms within 10 minutes. I have to pay £30 for a piece as long as my little finger and half the thickness. I find it very difficult because I only have my pension and mobility allowance. Here is another letter: I have a 36 year old son who developed MS when he was 18 years old. He has now got to the stage where he is wheelchair-bound and totally dependent on my husband and I for everything. He also has to sit with his legs elevated to waist height all the time because of pain in his legs. The doctors have tried everything they can think of but nothing works. They have now told us there is nothing they can do for our son. About a year ago, after much deliberation, my son decided to try cannabis and it worked. We told the doctors and they did not object to him using it, but because the pain is so bad he needs quite a lot, and this in itself causes quite a problem. The next letter is dated January 1997: We heard about cannabis through talking to others at respite centres he went to, and as most of our friends who would and did get this for us willingly refused to take away money, we decided to go it alone, so to speak", and use cannabis. That shows the sort of problems that are caused. I hope that the Minister will not condone the idea of people suffering from this disease being forced into the illegal market to find a form of treatment that helps them. The situation is truly appalling.

The law is being brought into disrepute. A recent headline in The Daily Telegraphread: "MS sufferer who turned to cannabis escapes jail". These people are not professional drug dealers: they are amateurs, and hence clumsy in their approaches. They find themselves threatened with prosecution, and although the police do not always press for prosecution, realising the humanitarian circumstances, and although the courts may hand down lenient sentences, the fact remains that people are being forced into illegality. The longer that that goes on, the more the law will be brought into disrepute.

The case for what I am saying is overwhelming. Does the Minister truly want people to find themselves in this position?

The second change since 1971 has been the growth of public support for the availability of cannabis on prescription for MS sufferers. All the polls show that. In California and Arizona, recent plebiscites have sanctioned the prescription of cannabis for certain specified conditions. In Italy, too, it is available on prescription—or rather, people can now grow their own if cannabis is prescribed for them by a doctor.

The last stage in the process of change finds expression in the BMA report issued at the end of last year on the therapeutic uses of cannabis, showing conclusively that it does have therapeutic value. That proves that the move from schedule 2 to schedule 1, denoting a drug of no therapeutic value, was wrong.

All that has changed since the 1971 decision. I emphasise that I am speaking about natural cannabis, not cannabinoids. The research we need is into the properties of natural cannabis, as the BMA report says. The BMA has no objection to research on cannabinoids—all the research has been on cannabinoids—but we need research on natural cannabis.

I cannot see why we do not have more research to develop a purified, standardised form. I hope that the Government will facilitate that research instead of inhibiting it, as they do at present. Each attempt to have cannabis made available on prescription is met with the argument that we need more research. It is a circular argument, because the Government do not allow the research that would provide the information.

I have taken two delegations of senior doctors—delegations so high-powered that I wondered why I was on them—to the Department of Health. The first occasion was in 1994, when we got a warm reception and indications that change was in the air. That vanished as the election approached and the usual fear about drugs and the panic that the subject produces took over. The second occasion was in December, when the reception that we got was more hostile and less supportive than in 1994 or before.

I believe that the mentality of the war on drugs produces such change in official thinking. I am not expressing an opinion on the war on drugs. It is partly a civil war waged by one section of society on another—on young people—but that is not my argument today. We cannot wage the war on drugs against the sick, including sufferers from multiple sclerosis. Parliament and public opinion would not put up with it. The police do not want it.

All the senior members of the police with whom I have discussed the matter think that cannabis could and should be made available on prescription, because that would remove that difficulty from the enforcement of the law. I hope that the Minister will ask our new drugs tsar, Keith Hellawell—a man for whom I have great respect, particularly for his Yorkshire common sense—what he thinks about whether cannabis should be available on prescription.

It is irrational to deal with the matter as we do. I am disappointed by the reaction to the delegation that I took last December. I want the Minister to recognise reality, and I want us to stop bringing the law into disrepute. I want us to help the vulnerable and to stop the run-around of arguing for more research when research is not possible.

I have great respect for the Minister, both in his previous legal incarnation and in his present health incarnation. He is a rational, highly intelligent Minister. I know, unfortunately, that will not get up in a couple of minutes and say, "My God, Mitchell, you are right." If he is, I am happy to give way, but I somehow think that that is not the way of Adjournment debates, unless they have been reviewed as another aspect of that review of everything that we have embarked on under the Labour Government. New Labour, new approach—it would be very welcome.

I am afraid, however, that we will get a defensive reply. I imagine that it might go on about consultations and further consultations, especially with the BMA. Such consultations have been going on for years, with no result and no action. We might get a reply about caution. Caution, and even fear and panic, have been the dominant tone since 1971.

If the reply highlights the need for further research, I point out that that research is not being done and is very difficult in the present circumstances. I would want licences for laboratory experiments and clinical experiments, and such licences may not be available unless cannabis is moved from schedule 1 to schedule 2. I hope that we will not be given the run-around on that. I fear that we shall hear more remarks about the war on drugs, but I should point out to the Minister that that muddies the issue, because it makes that war a war on the vulnerable.

Most such argument is not intellectually sustainable. It is irrational. If the Minister must deploy such arguments, he has obviously been told by superiors in the Government that, in the words of "Beyond the Fringe" at this stage in the war we need a futile gesture, and to go outside and make it. I hope that, while the Minister makes defensive noises, he grasps the essence of the issue. We need rational thought, and I want the process of rational thought to begin with a new Government taking a new look at a situation that has been deadlocked for far too long, with consequent suffering and illegality for the most vulnerable.

I hope that the Minister will initiate a process of thinking—a short one—by Ministers, officials, the Department, the Home Office and the drugs tsar, so that we end up with a more rational approach to the issue and move natural cannabis from schedule 1 to schedule 2 to make it available on a named patient basis for purposes of treatment. We cannot go on as we are. It is illogical, messy and disastrous for the war on drugs and for those who turn to cannabis for treatment. Let us take them off the front line and put them in a field treatment station, well away from the front line of the war on drugs. Please, let us have some rationality on the issue.

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 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 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 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


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—

Mr. Deputy Speaker (Mr. Michael J. Martin)

Order. We must now move on to the next debate.