§ 8.4 p.m.
§ Lord Perry of Walton rose to move, That this House take note of the report of the Science and Technology Committee on Cannabis: the Scientific and Medical Evidence (9th Report, HL Paper 151, Session 1997–98).
§ The noble Lord said: My Lords, although I used to be a pharmacologist I knew very little about cannabis when I was invited to be Chairman of this inquiry. Since then, I have learnt a very great deal from those who gave written and oral evidence. It was a fascinating experience.
I am enormously indebted to my colleagues on the sub-committee who gave unstintingly of their time and their skills. I am especially indebted—as we all were—to our specialist adviser, Professor Leslie Iverson, for his experience and expertise and for the work that he did with outside organisations. It almost goes without saying that our clerk, Andrew Makower, and his staff gave us their usual invaluable assistance.
I want to start by pointing out that the members of the sub-committee were completely unanimous in their recommendations. Also, the members of the Select Committee on Science and Technology were equally unanimous in endorsing the recommendations of the sub-committee. I do not think that this opinion—the opinion of two groups, which include quite a number of distinguished scientists and doctors—can be ignored. Nor do I think that it deserved to be dismissed out of hand by the Government on the very day that the report was published. I shall return to this point later.
Let me first describe the structure of the report. It starts with an introductory chapter describing the reasons why we undertook the inquiry. In the second chapter, we give a history of the use of cannabis over the years. It was first referred to in Assyrian tablets 672 2,600 years ago and it has been in continuous use since then in Asia, the Middle East and Europe. It was included in the Herbal, the pharmacopoeia of the time, of Dioscorides in Greece in about 60AD and was still included in the British pharmacopoeia of 1914. It is, indeed, said to have been used by Queen Victoria for period pains. Like all herbal medicines, it was recommended for a wide variety of illnesses for which it was virtually useless, but for some few it may well have had an effect.
In 1968, after the tragedy of Thalidomide, the Medicines Act was passed. This led to a system of licensing new drugs for use, imposing strict safety and efficacy requirements in addition to the quality controls imposed by the pharmacopoeia. These tests, including clinical trials, work well with new synthetic chemicals. They would not have worked with the herbal remedies such as the extracts of digitalis and raw opium which preceded them.
After a series of legislative changes, promoted by the rapid growth of the misuse of psychoactive drugs in the 1960s and 1970s, the current Misuse of Drugs Regulations 1985 became law. It classified controlled drugs either in Schedule 1, which banned their prescription altogether, or in Schedule 2, which permitted prescription by doctors for named patients. Heroin, which had well-known medical uses, was put in Schedule 2. Cannabis, however, because it was held at the time to have no known therapeutic value, was put in Schedule 1, although it was much less toxic than heroin. Had the pharmacological activities of cannabis been discovered at that time, this decision might well have been different and we would not have the problem we have today.
In Chapter 3, we describe these recent pharmacological discoveries. First, we describe how cannabis consists of a family of 66 chemically related cannabinoids plus some 400 other substances. Its main psychoactive ingredient is Δ9- Tetrahydrocannabinol, or THC for short. Cannabinoids are insoluble in water but soluble in fat. This limits the number of possible formulations for their administration. Smoking cannabis gives very rapid absorption, virtually in seconds. Administration by mouth leads to slow and irregular absorption and much cannabis is degraded as it passes through the liver.
The recent work that I referred to shows that there are receptors—specialised molecules—that are activated by cannabis. One set of receptors is in the brain, another in the immune system. There are also naturally occurring compounds in the brain that activate these receptors. They are called endogenous cannabinoids. Activation of these receptors leads in animals to potentiation of the action of morphine so that a smaller dose becomes effective. In the light of this new evidence, it is difficult to believe that cannabis has no therapeutic value since large doses of morphine not only relieve pain but also depress respiration—and cannabis, by allowing the use of a smaller dose of morphine, would help to prevent this.
In Chapter 4, we examine the evidence about the toxic effects of cannabis. There are two physical effects. It causes a mild increase in heart rate and a fall in blood 673 pressure. This would affect adversely only people with heart disease. The second physical effect is on the lungs if the cannabis is smoked. There is in regular smokers of cannabis an increased incidence of cough, bronchitis and asthma and, possibly, of pre-cancerous changes. There has as yet been no case of cancer of the lung, but it seems a fair bet that this will happen once people have smoked cannabis for long enough. Cannabis smoke contains all the carcinogens and as much tar as does tobacco smoke.
The other toxic effects are all psychological. In the short term, there is impairment of psychomotor function. This may affect driving, flying or operating machinery. But unlike alcohol, cannabis seems to make drivers careful rather than over-confident. Cannabis occasionally causes a psychotic episode lasting a day or two, but in the longer term heavy users can certainly develop severe cognitive changes and can become permanently stoned and incapacitated. This may happen in up to 5 per cent. of regular heavy users. It is not seen in those who use cannabis for medical purposes. Similarly, heavy users can exhibit tolerance of and physical dependence on the drug. It can also exacerbate schizophrenia in patients already affected by that disease.
All in all, the evidence shows that, on the one hand, cannabis does have serious toxic effects after heavy and prolonged use for recreation. But, on the other hand, it is easy to exaggerate its dangers when used medically. It has never caused death. It is easy in most cases to give up its use. It has fewer and less serious side effects than most of the active drugs used in modern medicine.
In Chapter 5, we review the medical uses of cannabis. Since all use is illegal, it is very difficult to obtain firm evidence. Nevertheless, we were impressed by the sheer volume of the anecdotal evidence for its successful use in treating the distressing symptoms of multiple sclerosis, and by the experimental evidence for its use in treating intractable pain. We found the evidence for its usefulness in treating epilepsy, asthma and glaucoma less convincing.
The British Medical Association of 1998 estimated that there were many thousands of users of cannabis for medical purposes. The Multiple Sclerosis Society estimated that at least 1 per cent. and possibly many more of the 85,000 sufferers from multiple sclerosis used cannabis illegally; that is, at least 1,000 patients. The Alliance for Cannabis Therapeutics has records of more than 200 patients who benefit from cannabis. In a postal survey of more than 100 patients, 90 per cent. reported alleviation of symptoms, especially of incontinence, muscular spasms and pain.
We warmly welcome the planned clinical trials of cannabis and the cannabinoids for both multiple sclerosis and for intractable pain which were announced during our inquiry. Indeed, our first recommendation is that such trials should be promoted as a matter of urgency. Both trials will, however, use cannabis and cannabinoids by mouth, not by smoking.
In Chapter 6, we discuss the use of cannabis for recreation. It is estimated that one in three of all those aged between 16 and 29 have tried smoking cannabis at 674 least once and that 7.5 million people in the UK have smoked it at one time in their lives. We felt, however, that the potential toxic effects of heavy and prolonged use were such as to justify maintaining the policy of keeping cannabis as a controlled drug.
In Chapter 7, we discuss the effect of changing the law about the medical use of cannabis. On the one hand, we agree with the Government that, to get a licence from the Medicines Control Agency there must be a standardised preparation of cannabis or a cannabinoid that is of approved quality and that has been tested by clinical trials for its safety and efficacy. Furthermore, we agree that any such licensed product should not be administered by smoking. On the other hand, we know that clinical trials will take at least five years to be completed. Was there any way that patients could be given cannabis legally without waiting for a licensed product?
It is indeed already possible for a doctor to prescribe THC because THC is in Schedule 2. This itself is anomalous since it is thereby held to have therapeutic value while cannabis, which contains it, is held to have none. Yet many users find cannabis more effective than cannabinoids in relieving their symptoms. Thus there is a logical argument why cannabis should be in Schedule 2. There was, as I showed earlier, an historical argument for it. We also felt that there was sufficient evidence of its safety in medical use, and of its efficacy, albeit anecdotal, in multiple sclerosis and for intractable pain for it to be so transferred. This was our main recommendation.
Finally, let me turn to the consequences of such a move. Doctors and pharmacists could manufacture and prescribe cannabis legally. The doctor could prescribe it in any form he chose—for oral administration, for smoking or for administration by any other route. We do not approve of smoking cannabis over a long period because of the potential risk of cancer. This is clearly, however, of no importance in patients dying from terminal cancer or AIDS. It is at least arguable that if one suffers from the distressing symptoms of a chronic disease for which there is no known cure, one would put the advantages of a better quality of life ahead of the misgivings about the potential risk of cancer. That is not to argue against the desirability of finding an alternative way of achieving rapid absorption without smoking. Indeed, we recommend that research to that end be promoted. It was recently reported that an aerosolised extract of cannabis will be used in one trial. That is, however, to put compassion ahead of anti-smoking principle.
I return to the fact that the Home Office Minister in the other place saw fit to reject our main recommendation on the day that the report was published, in the following words:
The Government would not be prepared to countenance any move to allow prescription before clinical trials and safety tests have been completed. The safety of patients is our first priority and the Government would not allow prescription of any drug which had not been tested for safety, efficacy and quality through that clinical process.".
Even if we accept that patient safety is the first priority, our report shows that if cannabis is used to treat patients on the prescription of a doctor, the risk to the patient
is vanishingly small. Furthermore, many patients would regard their safety as only their second priority after the quality of their lives. Should not the Government share that view? Is their attitude coloured by social, economic and criminological considerations to which our inquiry was not addressed? Those considerations are only pertinent to the recreational use of cannabis and should not be allowed to influence decisions about its use for medical purposes. The well being of patients ought to be paramount.
I call on the Government to give more mature consideration to our recommendations. I beg to move.
Moved, That this House take note of the Report of the Science and Technology Committee on Cannabis; the scientific and medical evidence (9th Report, HL Paper 151, Session 1997–98)—(Lord Perry of Walton.)
§ 8.22 p.m.
§ Lord Winston
I thank the noble Lord, Lord Perry of Walton, and congratulate him on chairing the committee in such an excellent manner. The committee sat for eight months and it was a pleasure to be part of those serious deliberations under the noble Lord's chairmanship and with the advice of Professor Iversen of Oxford. I thank also, as did the noble Lord, Andrew Makower, the Clerk to the Committee, who made its members swear a vow of chastity and silence over whether they had ever partaken of cannabis themselves.
This excellent report is modest in its remit and recommendations, and extremely contained and confined. It states simply that it is seriously important to consider the therapeutic applications of a potentially useful drug and that the drug may give some insight into neurological transmission because of its curious actions within the brain and the rest of the nervous system.
Control of pain is not an easy matter. There never has been and, I suspect, never will be a single drug that will control pain—particularly where it is neurogenic in origin.
Because the report is limited and the committee's aims objectives and considerations were constrained, this debate may be repetitious.
The British Medical Association, in the briefing that some of your Lordships may have seen, perhaps erroneously gave the impression that the committee did not distinguish between cannabis and the cannabinoids. That is untrue. We did make that distinction. We understood the difference between a pure form of the drug and a dirty drug—a drug having just the active compound or one that is contaminated. There is nothing wrong about using a dirty drug if it going to do the job. We use such drugs all the time. For the past 20 years, my own practice has been using FSH—follicle-stimulating hormones—which is not pure but derived from human sources. It has all sorts of proteins in it that are not wanted and which have unwanted effects. But until the recombinant drug was available this year, that was the only way we could stimulate ovulation. We did so successfully and many thousands 676 of babies have been born throughout the world without serious problems. So clean versus dirty drugs is not the issue. The principle of the use is key to the argument.
Are cannabis and cannabinoids so dangerous and potentially so devastating as to be more carefully and rigidly restricted than virtually any other drug—including methadone, morphine, cocaine and heroin? The answer must surely be no. Cannabis may have some rare dangers, possibly including cancer, neurological damage or psychological damage in certain susceptible individuals—but those risks are clearly much less than with many other drugs. Despite anecdotal claims, there is little evidence that cannabis will cause schizophrenia—although people who are predisposed to that condition, either genetically or for other reasons, may develop it during extensive use.
It is clear that toxicity of the compound is extremely low, causing perhaps four or five deaths in the past few years. Aspirin kills perhaps 50 people annually and so does paracetamol, which is widely available and can be bought over the counter at any pharmacist. Alcohol is responsible for far more deaths than any of those painkillers.
None of those limitations or worries about risks applies to carefully supervised risks. Many witnesses gave evidence of potential benefit. It seems that the few cannabinoids that are available in Britain on prescription have a limited effect on patients with the sort of pain that we are talking about. The patients in question are often desperately ill and dying of disease, and for them we must have great sympathy. Our report simply calls for proper evidence about the use of such drugs. We are not asking for recreational use. There is not the slightest evidence that, given proper controls, the implementation of our recommendations would increase recreational use in the slightest. Even if it did, there is no serious evidence to suggest that the consequence would be as dangerous as the misuse of existing drugs such as aspirin. The committee recommends that cannabis and allied compounds may be given by doctors orally, by pessary, by suppository or by another appropriate method on a named-patient basis. That would be the most modest change possible in the law.
It is disappointing that my honourable friend the Minister, who is a good and excellent Minister and a thoughtful man, was reported as saying that, essentially, the Governments position is inflexible. One report quoted him as saying:It would be irresponsible to say that it's OK to use it but there is no scientific evidence that it will work".That is always the dilemma faced in the use of any drug. One actually has to test it. It is equally irresponsible, if not downright hard-hearted, not to offer such drugs if there is the slightest evidence that they might work.
We need clinical trials. However, the Government's response issued within hours of this report being published was,We have not got rigorous scientific evidence that gives us absolute confidence that it is actually beneficial".That is our position. That is exactly what we are trying to establish; namely, evidence that these are beneficial drugs. As we have reported, that cannot be done with 677 the rigid controls that are currently in place. We need blinded, controlled, possibly crossover studies—standard pharmacological methods of examining drugs. That simply cannot be done with the current regulatory position. It is interesting to note that the proper use of these drugs could improve our understanding of the nervous system.
Currently we have a ludicrous catch-22 situation. I fear that the Government's response on this occasion was too hasty. It was an understandable knee-jerk reaction, but I fear that it is wrong. This is a serious committee whose membership comprises Fellows of the Royal Society, a Nobel prize winner and other distinguished members. If the Government are not prepared to take serious notice of this committee and are not carefully to consider its findings, it has to be said that perhaps there is no point in such a committee sitting at all. To ignore the careful and well-considered findings of such a committee would diminish an important function of your Lordships' House. It could also damage the esteem and respect in which the Government are held.
§ 8.31 p.m.
§ Lord Dixon-Smith
My Lords, I must admit that there were times yesterday afternoon when I thought perhaps I might be high on a cannabis trip! Fortunately I knew that that was not the case.
I undertook this study with a considerable lack of enthusiasm. I could not become interested in the subject. However, by the end of our deliberations I became fascinated by the subject and I learnt a great deal about it, as one so often does on these committees. It is one of the great privileges of taking part in such committees that one gains insights into subjects of which one formerly knew absolutely nothing. I am most grateful to the chairman of the committee and to the other members for tolerating me. I echo the disappointment of the noble Lord, Lord Winston, at the Government's apparent immediate rejection of the report. I hope that they will give the matter more mature consideration and will consider seriously the rather limited but specific and deliberate recommendations of the committee.
This is an unusual report as a large part of what we have recommended depends on what is essentially anecdotal evidence. We had to spend some time arguing about the nature of evidence and whether anecdotal evidence could be considered to be scientific evidence, and, if it was not, whether it could be considered to be evidence, and if it was not evidence, what was the point of hearing it anyway. Some 2,500 years of use of this substance must suggest something.
There is another aspect of the report I wish to mention; namely, that we do not recommend that something be made available for use which is not already available for use. It may be all too regrettable, but cannabis is virtually freely available, provided one can afford it. The price is not particularly high but undoubtedly the desire to possess the substance leads to a certain amount of criminal activity. However, for those who need it, cannabis is available. The report seeks to make legal what is at present illegal for those in 678 desperate need of it. We need to bear that distinction in mind. For some individuals, such as those who suffer from multiple sclerosis, cannabis is the best pain reliever they can have. It is good for pain relief and it is good for spasticity.
There is the recommendation to reschedule cannabis out of schedule 1 into schedule 2. That matter apparently will have to be considered by the World Health Organisation. I find it fascinating that a small change can have such wide implications. If it is accepted that cannabis can be prescribed by doctors on a named patient basis for a defined condition, then surely we are not doing anything to endanger the social fabric of society at large through a possible leakage into the general community that may occur as a result of that action. The idea is preposterous when one can buy a small amount of cannabis on any street corner if one wishes to do so. In any event the evidence we heard suggested that where legal action was taken for this offence, the courts treated those cases compassionately and they were generally discharged. I am immensely relieved that that is the case. I believe it would be grossly wrong if that were not the case. However, we have to deal with what is in effect an inconsistency in the administration of the law.
The chairman has already mentioned my next point; namely that the cannabis plant contains 66 separate cannabinoids. The evidence suggests that they work in combination and not individually. Rather like the vine, the make-up of the cannabis plant seems to vary with climate, geography and the system of cultivation. Cannabis is an immensely complex plant. Although it is wrong to use this comparison, I compare the cannabis plant with the vine. Two vineyards in separate locations will produce two dramatically different wines from exactly the same vine. One has to take into account that variation with regard to cannabis.
It seems to me that there are two ways to research this matter. One is to produce a standardised, consistent product which, of course, can be done by cloning plants. One then examines what effect that product has. The other way is what I call the lottery approach to research; namely, one recognises that there are 66 substances working in combination and one identifies each one and examines them. One then tries to sort out the ideal combination. Every week in this country the National Lottery is held with permutations of 50 numbers. Every week one or perhaps two people have the correct numbers. It seems to me that to apply that kind of approach to a critical examination of 66 separate cannabinoids is an immensely hazardous operation which is not likely to lead to quick success.
People with certain conditions need immediate relief. We believe five years of research may be needed to begin to discover in scientific terms the medical effects of cannabis. However, if we take the long route, we are not talking about five years but about a lottery. I do not think that is satisfactory. An MS sufferer needs something which gives immediate relief. MS sufferers have a condition which goes downhill from one plateau to another over the years. If their quality of life can be improved, that is worth doing.
679 In this regard, the method of application is critical. Cannabinoids dissolve very quickly in fat. Taking them orally is not very effective. It appears that pessaries are more effective, but all the evidence that we received was that smoking is the most effective way to dose with cannabis. One takes the smoke into the respiratory tract; it goes straight into the blood and then straight to the brain, where it acts, as the noble Lord the chairman of the Select Committee said, on the appropriate receptors and the pain is relieved. Relief is quick, but, on the evidence that we heard, not instantaneous, although one does not need to smoke even half a cigarette, in many instances, before pain is killed. The sufferer then stops smoking until the pain unbearably reasserts itself.
Each individual is different. Some will need a bigger dose than others. There is no way in which a standard dose will work. In all humanity, I conclude that if the choice is between insufferable pain, which is what these people are enduring, and smoking (with perhaps the risk of cancer 25 years down the line), I think that smoking is the tolerable alternative.
Considering all that, the committee still came to quite a clear view; that there could be no reason for relaxing the general restriction on recreational use. That was clearly stated in the report. It seems to me that in all humanity we should accept the recommendations of the report. I am glad to support the noble Lord, Lord Perry of Walton.
§ 8.41 p.m.
The Earl of Carrick
My Lords, I would like to start by saying how deeply impressed I have been witnessing your Lordships' House at work. Surely if all politics could be conducted with the same unfailing courtesy, care for detail and sheer commitment, society would be all the richer. I would also like to take this opportunity to thank the Officers of the House for their kind helpfulness from the moment I arrived last year.
It was with some trepidation that I put my name down for this debate and I sincerely ask for the indulgence of the House because I have chosen a subject for my maiden speech in which it is hard to say anything meaningful without being in some way controversial.
I was fascinated by the Select Committee's report on the scientific and medical evidence on cannabis. I shall not pretend to understand it all as I am neither a scientist nor have any medical knowledge, but certainly I have learnt plenty.
First, I should like to take this opportunity to say a few brief words about the whole question of drugs in general. I know that this is wide of the specific debate, but I believe that the subject is of vastly greater importance, economically and socially, nationally and internationally, than is reflected by the time and attention given to it by legislators.
I was staggered to read that in June last year the United Nations drug control programme estimated that the world trade in illicit drugs now stands at one quarter of a trillion pounds, which is to say, it accounts for 8 680 per cent. of all international trade, making it of greater economic importance than international trade in iron, steel or motor vehicles.
Of course, it is a fiendishly difficult problem where there are no right answers, which goes a long way to explaining a natural reluctance to confront the issue in the detail it demands. But it will only be through the most detailed discussions, with open minds, that progress will ever be made.
What we can say is that that quarter of a trillion pounds of world trade manifests in all manner of undesirable social consequences and costs. Unfortunately, the same old actions and attitudes that have failed—indeed, are likely, ironically, to be contributory to that failure—still hold sway, yet no matter how many resources are mustered, the problem gets worse.
We desperately need fresh thinking. So my first point is simply a heart-felt plea that greater time is given and action taken to make the situation better.
An editorial in the Lancet recently noted, echoing what we have heard from the noble Lords, Lord Perry of Walton and Lord Dixon-Smith, that,The desire to take mood altering substances is an enduring feature of human societies world-wide and even the most draconian legislation has failed to extinguish this desire … and this should be borne in mind by social legislators".Amen to the latter.
Speaking of our law-makers, to my mind one of the most important points, which is a legal and social one, rather than scientific or medical, raised in the document we are debating came in Chapter 8, where it states:If statute law is not enforced, Parliament is brought into disrepute; either enforcement must be tightened up, or the law must be changed".Austin Mitchell is quoted in similar vein, when in response to the fact that people who use cannabis for medical purposes face prosecution if caught cultivating or possessing cannabis, he was prompted to say:It is bringing the law into a certain amount of difficulty and disrepute because either the police are cautioning or the courts are giving very lenient sentences".This is indeed a dilemma for any government. If there are, as the report estimates, 7.5 million adults who have tried cannabis—approximately one-sixth of the entire adult population—and between 1.5 million and 2 million regular users, it stands to reason that legal foundations are being severely undermined. Either society is making a mockery of the law by disobedience on such a massive scale, or the law is making a mockery of society by criminalising over half a million people over the past 25 years, with all the attendant problems that implies for the individuals concerned.
Surely common sense tells us something is deeply awry here. Again, I return to my main point: all these issues must, for the good of us all, be given proper time for research and discussion with unprejudiced thinking.
Finally, turning to the purely medical aspects of the report, my abiding impression is that there are compelling reasons for further detailed medical study of what appears to be a source of enormous potential to ease suffering. A substance that, even in its crude form, 681 can be used with unquestionable effect—although to differing degrees—to help sufferers of MS, cerebral palsy and glaucoma, surely demands attention and study. Add to that anti-emetic effects, analgesic properties and the ability to assist prevention of weight loss in anorexia, cancer and AIDS and we have a substance already of value.
No matter that in some cases there are better drugs currently available: the fact that cannabis has such a wide range of beneficial effects is extraordinary. Even if my understanding is far from that of a scientist, it is strikingly obvious to me that Professor Wall is right when he says (in Chapter 4):It is a paradox that a subject of such intense scientific interest should receive so little clinical attention … this is regrettable since there is a wide range of possibilities and massive opportunities for research".Add to that, Dr. Robson's (in Chapter 7) remarks that:The present licensing system and policy has severely limited research and should be reviewed",prompting the observation that the United Kingdom's academic community and pharmaceutical industry may miss the opportunities if the research licensing regime is not relaxed.
Given the high standing of our academic community and our world-leading pharmaceutical firms, this is surely unwise. It is noted in the report that the United Kingdom's attitude towards cannabis is one of the most restrictive in the world, so too many other countries are being allowed a head start. Surely in this, as in most matters, the government of the day must strive to provide an environment for intellectual clarity and business advantage.
To me, the authors of the report are motivated purely by a compassionate wish to allay human suffering and a proper desire for unfettered scientific exploration of cannabis in all its component forms. On that basis, I wholeheartedly support the Select Committee's specific recommendations.
§ 8.48 p.m.
§ Lord Kirkwood
My Lords, it is my pleasant duty to congratulate the noble Earl, Lord Carrick, on his excellent maiden speech and wise words. We hope to hear a great deal more from him in the remainder of his shelf-life, as he is, like me, an hereditary Peer.
First, I should declare that I too was a member of your Lordships' Select Committee which, under the able chairmanship of my noble friend Lord Perry of Walton, inquired into cannabis and produced this report.
The report's recommendations are few in number. They are brief and succinct. Some refer to the need for proper clinical trials of cannabis and alternative modes of administration of the drug. We have recently learnt that such work has already started with the grant of a Home Office licence for the cultivation of cannabis plants of known provenance, grown under carefully controlled conditions to produce a drug of reliable consistency. All that is to be welcomed.
The most radical and controversial proposal, however, has been greeted by the Government with distinct coolness and, as the noble Lord, Lord Perry, 682 said, almost instant dismissal by the Home Office Minister. I refer to the rescheduling of cannabis from schedule 1 to schedule 2, from a position in which it cannot be prescribed by a doctor for a patient as a medicine for the relief of distressing symptoms such as pain, nausea, muscle spasms and so on, to one in which it is permissible on a named-patient basis.
It has to be said that in making such a radical change one must be careful not to send out the wrong signals. There is evidence that the abuse of cannabis can lead to health problems, particularly if it is smoked, and in some cases psychological disorders. For those reasons the committee could not support the general legalisation of the drug—and the rescheduling recommendation has nothing to do with that. On the contrary, by clearly distinguishing between the therapeutic use and the recreational use of cannabis, the committee believes that the problem for the law enforcement authorities of tackling abuse should be made easier.
The Government maintain that they need hard scientific evidence as to the efficacy of natural cannabis as a drug before they can act. But there is ample evidence, and ancient evidence, that relief is obtained by people who are suffering pain even using small dosages of the drug, and in many cases relief comes rapidly. Admittedly, the evidence is anecdotal, not hard scientific fact. But at present people are willing to break the law and run the risk of being prosecuted, with all that that entails, because they can find relief for their condition in no other way. In many cases their GPs are sympathetic to their practice.
There is no question that the whole situation is highly unsatisfactory. People who are normally law-abiding citizens are being made into criminals, and the illegal drug trade profits from selling cannabis of unknown and possibly harmful quality. Certainly there is a need for properly controlled research into the benefits and hazards of cannabis use, and thankfully that has now started.
However, it is estimated that it will take at least five years before sufficient trials have been carried out and for the Medicines Control Agency to recommend to the Government, if the results are positive, the rescheduling of the drug. In the meantime, 85,000 people in this country will be left to suffer, some in great pain, and perhaps needlessly.
It all comes down to the need for hard evidence. As Professor Joad might have said, "It all depends on what you mean by hard evidence". I work as an experimental scientist, and I am fully aware that evidence for many scientific conjectures is often slight. One-hundred per cent. certainty in science does not exist, although many scientists would suffer martyrdom for their belief in the laws of thermodynamics. Certainty in the medical sciences is even more tenuous, because they deal with notions such as pain and its relief where rigorous objective testing and measurement are difficult. Often we have to act where we have less than certainty, even while we endeavour to improve our knowledge.
I urge the Government, in this situation, while they strive to encourage further research, also to feel compassion for those sufferers—often from terminal 683 illnesses—and also to show courage in facing the inevitable reaction of those who talk about a small step opening the floodgates to wholesale drug abuse, to allow doctors to provide this relief to those suffering the distressing symptoms of multiple sclerosis, AIDS and terminal cancer, by allowing the prescription of the drug in a controlled manner and on a named-patient basis.
§ 8.55 p.m.
§ Lord Porter of Luddenham
My Lords, it has been a privilege to serve on your Lordships' sub-committee on cannabis, under the wise and expert chairmanship of the noble Lord, Lord Perry of Walton. The problems that we discussed were largely medical, and the committee had no shortage of expertise in this area since half of its members, six out of 12 including its chairman, as well as its specialist adviser, are medically qualified, all of them very distinguished in their field.
We had experienced advice in some of the other areas which bore upon our problems, such as the law and the special problems of prescribing by general practitioners. We also owe much to the committee's Clerk, Andrew Makower, for his drafting skills in preparing an account of our views which we could all accept—not an easy task.
I am not medically qualified, and speak only as a chemist. In that capacity I noted with interest and pleasure that the chairman of your Lordships' first committee on science and technology, in 1979, was my noble friend Lord Todd. Even more to the point, when he was a professor of chemistry in Manchester and at the Lister Institute, he carried out some of the earliest research on the chemical composition of the active components of cannabis. If noble Lords will allow me to introduce just a little levity into what is of course a very serious matter, they may be interested in Lord Todd's encounter with the Home Office and his own possession of cannabis.
In 1936, Professor Todd went to the Lister Institute, where, among other biochemical problems, he began work on the active principle of cannabis sativa. The starting material for his studies was a distilled resin extract of hashish which had been seized by the police in India. It was obtained from them by a chemist, Fritz Bergel, who transmitted it to Germany in the diplomatic bag and thence in a suitcase to Edinburgh through the port of Leith. The Customs showed no interest.
In the Lister Institute, Professor Todd isolated cannabinol (not tetrahydrocannabinol, which is the active component) from the resin and showed that it was pharmacologically inert. That work was published in Chemistry and Industry ("Blue Bits" as we used to call it) and within a few days some interest was shown—by the Home Office! They invited Todd to meet their inspector at his earliest convenience.
When asked where he got the hashish, he had to reply, "from the Indian police". "How much of the stuff have you got?". At this point his answers became even more startling: "Two-and-a-half kilograms". "Good God!", exclaimed the inspector. But he recovered his poise and agreed to make Todd a licensed holder of cannabis on 684 condition that the professor would send 25 reprints of his publications. "Certainly. Where shall I send them?" asked Todd. "Send them to me", said the inspector, "at the bureau of drugs and indecent publications".
Today the Home Office seems to be less liberal in these matters. Indeed, as we have heard, within hours of receiving the report of your Lordships' committee on cannabis, with its recommendation that, for the time being, cannabis should be transferred from schedule l to schedule 2, the Minister had made up his mind to do nothing of the kind. This was known to be the most controversial of our recommendations, but it was made after taking evidence lasting some seven months, and it was unanimous. The government reply to our earlier report on antibiotic resistance took eight months to arrive, which is much too long, but at least the Minister had time to read it.
I confess that personally I have found it difficult to decide on this matter. As a chemist, I have no difficulty with the prescription and trial use of well-specified pure chemical substances such as cannabinoids, whether synthesised or extracted from cannabis resin. But the medico-chemical study of a natural cannabis of variable composition containing more than 60 cannabinoids and several hundred other chemical compounds is, to put it mildly, a daunting research project and one which is likely to take a very long time.
There was no doubt in the committee that any relaxing of the regulations on cannabis should apply to medical uses only on prescription. We are all aware that scientific proof of safety is not available and probably will not become so until after five or more years of clinical trials.
In spite of the difficulties, we regard the clinical trials which are being launched by the Royal Pharmaceutical Society as the first priority. If these are to be licensed, further research will be necessary into new, safer methods for delivery, such as inhalation, which was referred to by the noble Lord, Lord Dixon-Smith, and others. Until these are successfully completed, however, we believe that, on compassionate grounds, as well as removing restrictions which bring the law into disrepute—which is almost equally important—justice would best be done by the rescheduling of cannabis so that, like its active ingredient Δ9-tetra-hydrocannabinol, and like cocaine and morphine, it could be prescribed on a named-patient basis, to relieve the pain of sufferers from, for example, multiple sclerosis. Genuine users for medical reasons could then be distinguished from recreational users simply by producing their prescription.
In conclusion, we heard encouraging evidence from our witnesses of new research on the pharmacology of cannabis and how the body contains naturally occurring "endogenous" compounds—to which the chairman of our committee referred—that can activate cannabinoid receptors. There are two known receptors called CB1 and CB2. Only CB1 exists in the brain and CB2 is therefore not expected to have the unwanted pyschoactive effects associated with cannabis, while agonists to CB2 may well have beneficial effects in modulating immune responses.
685 As understanding of the brain advances apace, these discoveries have transformed the character of scientific research on cannabis. But, although there is increasing scientific interest in cannabis pharmacology, there is little clinical research or commercial development work at present. Some attribute this to the added difficulties of working with a schedule 1 drug—the Royal Pharmaceutical Society refers to the "burden of licensing". A further advantage of moving cannabis to schedule 2 of the regulations would be that licences for research in this new and exciting area of medical biochemistry would no longer be required. I hope that the Minister will give a little more time to considering some of these matters before he persists with his blanket restrictions.
§ 9.4 p.m.
§ Lord Mackenzie of Framwellgate
My Lords, I welcome the report of the Select Committee dealing with the scientific and medical evidence on the use of cannabis. I congratulate the noble Earl, Lord Carrick, on his maiden speech, which I particularly welcomed because, apart from myself, he is the only speaker so far who was not a member of the committee. I suspect that, had I been a member of the committee, there might have been one dissenting participant. I do not share the disappointment of previous speakers at the Government's response to the report.
I should perhaps declare an interest, although I have some trepidation about doing so in view of the comments of the noble Lord, Lord Porter. I am the former head of a police drugs squad. I am not a scientist or a medical expert, and I bow to the learned witnesses who gave evidence to the committee. The fact that a law is broken regularly is not an argument for legalising the activity. If it were, we should not have laws against speeding.
I speak from my experience as a police officer dealing with the effects of drug abuse, both on the abuser and on the wider community. Cannabis is an intoxicant—or, more accurately, THC, the active ingredient, is an intoxicant. It alters perception and, as the report says, after smoking, which is the most common way of using the drug, the psychoactive effects are perceptible within minutes. The report reminds us that the drug persists in the brain longer than in the blood, so the psychological effects persist for some time after the level of THC in the blood has begun to decline.
It is my experience from reading—certainly not from personal knowledge—that the THC in cannabis has increased dramatically in the past few years, and there was evidence before the committee to this effect. I have seen reports that in the 1960s it was 1 per cent., whereas now in some products it is almost 30 per cent.
There is evidence that use causes mood changes, loss of memory, psychosis, impairment of co-ordination and so on. The report tells us that no one has ever died as a direct result and immediate consequence of recreational or medical use, and I accept that, although there are doubts in relation to some road accidents. The report points out the dangers of driving a vehicle or flying an aircraft while intoxicated following usage of the drug. I 686 believe that liberalisation of the law will increase the number of people who use the drug. In Holland it is estimated that the use of cannabis has trebled since the 1980s when it was decriminalised.
The report points out that cannabis intoxication is difficult to monitor, and that is true. There can be no equivalent of a breathalyser for alcohol since small amounts of the drug continue to be released into the blood long after any short-term impairment wears off. Therefore, for the reasons that I have outlined, I am delighted that the committee endorses the Government's statement in Tackling Drugs that,The more evidence becomes available about the risks of cannabis … the more discredited the notion that it is harmless".Recreational use is therefore ruled out quite correctly.
What causes me greater difficulty is the recommendation that cannabis should be transferred from Schedule 1 to Schedule 2 of the Misuse of Drugs Regulations, thereby allowing doctors to prescribe and pharmacists to supply the drug for medical purposes. The committee has in a sense jumped the gun. There is a contradiction. Throughout the report, it is stated that the most common method of taking cannabis is to smoke it. For example, that is why in paragraph 8.4 it is recommended that research be promoted into alternative modes of administration because of the well-known dangers of smoking. Professor Heather Ashton of the University of Newcastle is reported as saying that,smoking cannabis leads to three times greater tar inhalation than tobacco. Chronic use increases the risk of cardiovascular disease, bronchitis, emphysema and lung cancer".The report itself states in paragraph 5.54… there are anecdotal reports that those who use cannabis for medical purposes favour smoked cannabis over orally administered cannabinoids".If the authorities change the scheduling of, say, cannabis resin how does the committee envisage users will administer the prescribed drug? I would have no objection at all to pills being prescribed to be taken orally but the report is unclear as to how it is envisaged cannabis is to be administered before clinical trials have taken place. I do not believe that any responsible person would suggest the use of a disease-causing and life-threatening method of treatment in order to alleviate pain and suffering caused by any medical condition. If prescription for smoking were allowed history tells us that it would be abused.
I have often said that the ardent campaigners for the decriminalisation of this drug for medical use see such tactics as a Trojan Horse for the eventual legalisation for recreational use of not just cannabis but all drugs. Having spoken to law enforcement officers in the US, it is apparent that in those states where it has been legalised for medical use it has become increasingly difficult to enforce the law generally. Contrary to the argument of my noble friend Lord Kirkwood that law enforcement would be made easier, the experience in the US is the other way. I believe that we go down that road at our peril.
The Government are surely right to wait until the results of proper clinical trials are forthcoming before cannabis is made available for medical use. Cannabis is 687 defined by the United Nations as a dangerous narcotic. It should remain such here until we are properly satisfied by evidence to the contrary. I believe that the response of the Government is absolutely right.
§ Lord Winston
My Lords, before my noble friend sits down, perhaps I may put one question. First, is he aware that it is possible to administer drugs nasally or by rectal suppository? Secondly, does he agree that if he reads the evidence that is set out carefully in the report one of the matters constantly referred to by many of the people who currently use cannabis illegally is that they try to avoid becoming intoxicated by the drug if at all possible? They want pain relief but do not want the "high" about which my noble friend complains. Perhaps my noble friend would like to address that issue briefly.
§ Lord Mackenzie of Framwellgate
My Lords, I am grateful that my noble friend raises that point. I am aware that there are other means of administering the drug. My point is that the prescription system will be abused. Unfortunately, doctors, policemen and many other people in society break the rules. In response to my noble friend, perhaps I may quote the words of the British Medical Association:… the report's recommendations are contradictory. The report rejects smoking as a suitable method of taking the drug and wants doctors to prescribe an 'appropriate preparation of cannabis', probably an oral capsule. However, in the accompanying press release the House of Lords Committee envisages that producing a prescription would be sufficient evidence in defence against a charge of possession of cannabis. That clearly implies that patients will continue to use crude cannabis, a route the BMA rejects because of the harmful effects of smoking and the unpredictable nature of its effects".I believe that that answers the point. The prescription system would unfortunately be abused. I believe that clinical trials are essential before we go down that road.
§ 9.14 p.m.
§ Lord Butterfield
My Lords, I rise in the lull after that devastating bowling attack on our wicket, but I believe we shall shortly be able, with the passage of time, to recover ground and come back into the game. Perhaps the next speech will achieve that.
I wanted to say first of all, like the others, how much I enjoyed sitting on the Committee with my old friend Lord Perry of Walton. He used to play cricket for me: perhaps that is why I am speaking of great bowling efforts from the last speaker. We used to play cricket together for the Medical Research Council and do our best to defend our reputations and our castles in that way. May I just say also that we were immensely lucky in our Clerk? He had a very clear mind and I do not think anyone could fault the logic of the way he presented the material and the boxes he constructed in the report. In Professor Leslie Iverson, an expert witness, we were very fortunate to have someone who is at the absolute forefront of modern cannabis pharmacological research.
What I was hoping your Lordships would let me do—and I do not want to take up too much of your time—is to say that I have been reminded since going into all 688 this about cannabis and pain that a very long time ago—50 years—when I was in the Royal Army Medical Corps I did some work on pain from radiant heat. I will not bore your Lordships with my descriptions of how a hard-working young doctor found himself in such a circumstance, but the sound advice of the SA/Army Council led me to be transferred to his care, that is, for his use in the corps. The problem that he put to me was that he wanted to know what radiant heat from air-burst nuclear weapons could do. And we got busy. It did not take us very long to show that it could ignite inflammable clothing. That set us off on the great drive to help the Army find uninflammable materials from which to make the uniforms of the British Army. I like to believe that we made a contribution in that field.
However, as a young group of physiological Army research workers, we were really much more interested intellectually, looking back I now realise, in the effects of the other end of the intensity of the radiant heat story. We became very interested in the pain you can get from radiant heat. You may well, for example, lie for some time in the sunshine in your garden and suddenly be woken up by the sharp focus of light on your leg by one of your naughtier children.
When we were looking at this one of the very first things we realised we had to find out was how big an area of the skin of our volunteers—not policemen but soldiers—should we irradiate to see what were the threshold doses of radiant heat which could produce the effects we might be interested in. This, I now realise, led us to a most interesting situation because we found that if you irradiated an aperture of say 3cm in diameter you got a threshold for pain—you felt it and it hurt—but if you reduced the size of the aperture you could give more heat before you got the painful sensation; and if you reduced it even more you could give even greater amounts.
The only report we could write for the scientific advice of the Army Council—we did not use it very much—was one that we called Studies and Observations in the Royal Army Medical Corps on the Central Summation of Pain. As you can imagine, the authorities wanted to know what on earth that had got to do with the atomic bomb. I now realise in retrospect that this central summation of pain could be a very quick way of looking for an effect from the cannabinoids; I am not going to say smoking marijuana or THC and other products which we could take as a tincture, I suppose, or whatever. In this way we might perhaps be able to come up with a quick piece of evidence that this compound, which is reputedly graced with all kinds of important qualities, indeed has some.
I am pleased to realise that there are people such as Professor Wall at the United Medical and Dental Schools of St. Thomas' and Guy's Hospitals, who is a big worker in the field of pain. While I am not up to date with the names, I wish to have these in the record because people in the research world do not receive their just deserts. There is a lady at Hammersmith called Dr. Holdcroft. Dr. Stewart of Dundee has worked on phantom pain in limbs. There is a Dr. Lambert at Leicester; and Professor Notcutt is very interested in these problems. I wish to have their names in the record 689 not least because I believe that the time comes—and this is such a time—to give encouragement to those who work in the field.
By doing some physiological experiments on pain we may be able to find out whether the cannabis cannabinoids could have an effect on pain. If so, it will give a great thrust to bringing a reasonable proposition to the Government for ongoing research.
I noted the words in the report about there being a certain stigma about research into cannabis. It is most unfortunate. Before too long, I hope that we shall without too much stigma be able to take Professor Mackenzie along with us in the search for suitable preparations. Perhaps patches, pills, or inhalations such as I take for my asthma may bring necessary relief on to the sites—the nerves—for those people who have these painful and worrying conditions.
I feel guilty if I obstruct relief for pain for people towards the end of their years. We have to be careful about cannabis when dealing with young people. However, I think that older folk can take bigger risks with the effects of the compounds. I thank noble Lords for listening to me.
§ 9.22 p.m.
§ Lord Walton of Detchant
My Lords, it was a particular pleasure to have served on the sub-committee which produced the report for your Lordships' Select Committee on Science and Technology which we are now debating. Like other noble Lords, I wish to pay a warm tribute to the outstanding leadership and chairmanship of the noble Lord, Lord Perry of Walton, whose judicious handling of the evidence and whose guidance was outstanding throughout, as indeed was the advice given to the sub-committee based upon his encyclopaedic scientific knowledge and experience by its adviser, Professor Leslie Iversen. As others have said, we must not overlook the exceptional drafting skills of our clerk, Mr. Andrew Makower, with whom I have had the privilege of working several times in the past. His command of the English language, his ability to interpret evidence and comprehend and analyse complex scientific arguments have been impeccable.
Let me say, first, as others have done, that we were in no doubt that cannabis should continue to be a controlled drug, since, although it is not highly addictive, it can lead to psychological dependence; and in some dependent individuals regular heavy use can produce a state of near-continuous intoxication making normal life impossible. In addition, it is sufficiently intoxicating so as to impair the ability to carry out critical tasks such as flying, driving or operating machinery. That effect lasts for several hours, and possibly for much longer after taking it.
My especial concern relates to the evidence that the drug impairs cognitive function during its use and may indeed, in heavy dosage, produce long-term cognitive decline. From my long experience as a neurologist, I can also confirm that it can clearly exacerbate pre-existing mental illness. Indeed, in heavy dosage, it can produce a delusional psychosis with hallucinations which can lead to a mistaken diagnosis of schizophrenia.
690 Many years ago I met a bright medical student from overseas in whom such a psychosis developed due to heavy cannabis consumption of which his doctor and family were totally unaware. Schizophrenia was diagnosed. He was treated with powerful neuroleptic drugs and developed severe and irreversible side effects which made it impossible for him to continue what had seemed likely to become a promising career in medicine.
Those who argue that cannabis may be no more dangerous in the long term than tobacco, for example, must recognise that if tobacco were now to be introduced into UK society for the first time, it is my view that because of its appallingly harmful effects, it too would now be a controlled drug.
Those facts indicate clearly that recreational use of cannabis must continue to be illegal. Its effect of lowering blood pressure, a particular risk in individuals with cardiovascular conditions, is another important factor.
If, then, the drug has such important and troublesome side effects, why did our sub-committee recommend that it be moved from Schedule 1 to Schedule 2 under the Misuse of Drugs Act, allowing its prescription by doctors for named patients only? Why did we suggest that, since the synthetic cannabinoid analogue nabilone is licensed for use under Schedule 2 while dronabinol, pure THC, although not yet licensed in the UK, is also in Schedule 2 and could be prescribed for named patients?
I must reluctantly admit, having been a fervent supporter throughout my professional life of the controlled clinical trial, and having organised and conducted several such trials in the treatment of neurological disorders, that there is logic in the suggestion that it might be better to await the outcome of the trials now being planned by the Royal Pharmaceutical Society with the collaboration of GW Pharmaceuticals.
Many scientists and doctors, whose opinion and professional expertise I respect, such as Sir William Asscher, who will be supervising those trials, have argued that the sub-committee should have awaited the completion of those studies and that the Government should delay moving cannabis from Schedule 1 to Schedule 2 until the results have been analysed.
Why then did the sub-committee appear to fly in the face of informed pharmaceutical and clinical opinion by making the recommendations that we did? Our reasons were fourfold. First, there is increasing evidence that cannabis and particularly its constituent cannabinoids have some predictable effects upon the central nervous system where, through their action upon cannabinoid receptors, they may potentiate, as the noble Lord, Lord Perry, said, the effects of analgesics. In consequence, in patients with terminal cancer, the doses of drugs such as morphia or heroin required for pain relief may be less if cannabis can also be given. There would then be a consequent reduction in side effects.
Secondly, it now appears that cannabinoids, combining with such receptors, can have a beneficial effect upon spasticity—the cause of the painful spasms 691 in the lower limbs which may afflict patients with advanced multiple sclerosis. Recent scientific studies reported in Nature and reviewed in the September/October 1998 issue of BrainWork, a newsletter of the international Dana Alliance for Brain Research, of which I am a UK member, has raised the possibility that another cannabinoid called anandamide, not yet available for medical use, may relieve nerve pain when injected peripherally, as CB receptors are also present in the limbs. That would mean that pain relief could be achieved while avoiding any psychoactive effects. The international tide of medical and scientific opinion is moving rapidly in favour of our recommendations.
Thirdly, while I must accept that virtually all the clinical evidence presented to us in the course of our inquiry was anecdotal, nevertheless, we found it convincing. Therefore, we think it likely, although by no means certain, that cannabis may be an effective remedy for the painful spasms of MS and that it may also have a significant potentiating analgesic effect as well as offering effective control of the nausea and vomiting which may complicate AIDS and chemotherapy for advanced cancer.
The fourth reason underlying our recommendations was not based solely upon compassion for those suffering from the disorders to which I referred who have found the illegal consumption of cannabis beneficial. But we heard much evidence—yet again anecdotal—strongly suggesting that natural cannabis, however administered (usually at present through smoking), had proved effective when the synthetic tetrahydrocannabinol analogue, nabilone, had not. And for this reason we did not regard it as being fair or reasonable to wait five years for major trials to be completed before making cannabis available.
I understand fully the strictures included in recent statements by officers of the BMA and by Sir William Asscher; they stressed that herbal cannabis, containing a mixture of more than 60 cannabinoids, is not yet available as a pure preparation. In their view natural cannabis, however administered, could have unacceptable toxic effects. In response I can but say that the evidence which we received—for example, on behalf of patients with multiple sclerosis—was, first, that the level of dosage of herbal cannabis required to relieve their symptoms produced relatively few psychoactive effects; and, secondly, that the amount required was not such as to carry a risk of producing the major toxic effects which high doses of cannabis are known to cause.
We were much encouraged in our view by the knowledge that Dr. Geoffrey Guy of GW Pharmaceuticals has obtained a Home Office licence to cultivate natural cannabis with the intention of producing a purified herbal preparation which, it is hoped, will produce consistent or at least reasonably consistent blood levels of THC when specific doses are administered. Proof that this will be feasible will take some little time to achieve; but in the meantime, in the interests of the patients with the conditions I have mentioned, I am now persuaded—against my original 692 scientific judgment—that limited trials in known patients should be allowed on medical prescription using such a natural preparation when available. Clearly the drug should not be used in individuals with cardiovascular disease in whom the effects upon the heart and circulation might prove damaging.
Another powerful reason for suggesting that such a herbal preparation should be made available under Schedule 2 was based on evidence we received that, because of the presumed beneficial effect of natural cannabis, as others have said, some doctors have apparently connived at its illegal use. Whenever evidence of such behaviour on the part of doctors and patients has been brought formally to the attention of the law, the individuals have usually been treated leniently. In other words, much of society seems now to be condoning illegal use specifically for medical purposes; it was our conclusion that that position should now be regularised without waiting for the results of lengthy clinical trials.
The question then arises as to how such a natural preparation should be administered. Here it is clear, as our report confirms, that much research is needed as smoking of cannabis could be tolerated only in the very short term since smoked cannabis carries just as much risk of causing cancer of the respiratory tract as does tobacco smoking; indeed, as Professor Ashton said, it may be even more harmful. Hence any natural preparation made available for prescription must be tested in alternative formulations. Inhalation of an aerosolised extract is the method most favoured but sublingual administration or administration by a pessary or a suppository must not be overlooked. Each of those techniques should produce more effective blood levels of cannabinoids than would ingestion, in view of the inevitable delay resulting from absorption through the gastro-intestinal tract with metabolism in the liver.
Of course, the question will inevitably be raised, as it was raised by the noble Lord, Lord Mackenzie of Framwellgate, as to whether legalisation for medical purposes might be regarded as a stalking-horse for legalising recreational use. I am satisfied, as our report makes clear, that we must reject that suggestion. Similarly, we are well aware that even in the most carefully regulated societies there will always be a possibility that a prescribed drug will be diverted to illegal use as has sometimes happened with morphia, heroin and their analogues. That is a matter of which, as a former president of the General Medical Council, I am only too well aware. But I believe that the professional regulatory authorities are fully aware of that potential problem and would be expected to deal just as harshly with those involved in diverting prescribed cannabis to improper use as they already are in relation to the diversion of heroin, for example.
Like many other members of the sub-committee, I was dismayed by the immediate knee-jerk reactions of the Government and the BMA to our report at a time when surely neither could have read it fully so as to comprehend the cogent reasons underlying our proposals. So compelling, I believe, is the anecdotal evidence which we heard, and to which we have referred in depth, that I firmly adhere to our recommendations.
693 I urge the Government now to consult the Advisory Council on the Misuse of Drugs and to delay their formal response to our report until after they have received and considered the advice of that council. We trust that that body will agree with our conclusion that an appropriate preparation of herbal cannabis should be transferred to Schedule 2 under the regulations and that the Government should raise the matter of rescheduling the remaining cannabinoids as they become available, with WHO in due course in order to facilitate research into their use.
All who served on the sub-committee were well aware that, in making the recommendations that we did, we were in a sense flouting conventional medical and scientific practice. At the risk of undue repetition, I can only say that we would not have done so were it not for the volume of written and oral evidence presented to us, relating to the experiences of individual patients, but also to current scientific knowledge. We are convinced that it is important for the well-being of many individuals that limited amounts of natural cannabis should soon be made available for prescription by doctors to named patients only. I trust that the Government and those professional bodies in medicine which have commented adversely upon our report, in striking contrast to the almost universal support that it has received in the public media, will now think again.
§ 9.36 p.m.
§ Lord Rea
My Lords, like other noble Lords, I should like to say, first, what a privilege it was to be yet again co-opted on to the sub-committee and to serve under our excellent and learned chairman and specialist adviser. I say "learned" in this case in the scientific sense. Of course, I shall not neglect to mention the work of our excellent Clerk and his team.
Apart from our report and recommendations, with which I fully agree, I should like to point out that the volume containing the evidence presented to the committee is, as pointed out by the noble Lord, Lord Perry, a fascinating and valuable read in itself. It is extremely cogent and quite difficult to put down, as some of its pages are so fascinating. It will prove to be a most valuable source document in the future for anyone interested in the case for or the case against making cannabis legal and more accessible, whether this be for medical or so-called "recreational" purposes. It is also an accessible and well-referenced account of the whole subject.
Like the noble Lord, Lord Walton, I should like to mention that we looked at the adverse effects of the drug in great detail, as well as looking at its possible medical benefits. Those adverse effects are summarised in paragraph 8.19 of the report. Our final recommendation, which the noble Lord, Lord Walton, iterated—and I shall repeat—is that,cannabis and its derivatives should continue to be controlled drugs".That does not mean that the sub-committee felt that cannabis was more dangerous than tobacco or alcohol. In fact, we felt that both of those substances were more harmful to health than cannabis. Indeed, the noble Lord, Lord Walton, stole the phrase which I was going to 694 attribute to Virginia Bottomley, but which she actually got from ASH; namely, that if tobacco were to be introduced today, with our current knowledge of its dangers to health, it would not receive a licence.
The committee was surprised, at least I was, that there were no deaths—I repeat, no deaths—directly attributable to cannabis toxicity either from acute overdose or prolonged use in the years 1993 to 1995. That is certainly not the case with many medicines which are obtainable over the counter. My noble friend Lord Winston mentioned paracetamol and aspirin, suicides from which we heard about during Question Time about two weeks ago on (I think) 18th November. So cannabis really does seem to be safer from the point of view of its lethal consequences than aspirin. Indeed, this very safety was a major factor in our recommendation that it should be moved from schedule 1 to Schedule 2. But because of its psychotropic power and possible long-term neurological effects, which have been described so well by the noble Lord, Lord Walton, it was felt that it should remain a controlled drug.
I would like to add a personal view here. If the possession of cannabis were ever to be decriminalised or legalised—which some may say is a sensible policy, but that is well outside our committee's remit—its supply should still be controlled and monitored carefully. This would be much easier if it was classified as a controlled substance, only available from licensed sources.
As I have said, the committee's remit did not include consideration of the "recreational" use of cannabis, yet our deliberations and recommendations always had to bear in mind the sort of criticisms that the noble Lord, Lord Mackenzie, has brought forward—that our recommendations might be misinterpreted as being the "thin end of the wedge", a "stalking horse" or, as he said, a "Trojan horse", leading to the medical prescription of cannabis for its psychotropic effects.
There is little or no problem when discussing the prescription of purified cannabinoids since they are not, as far as I know, ever sought by recreational users. But cannabis itself may seem, on the face of it, to be more problematic. This is not necessarily so. As other noble Lords have pointed out, heroin is a prescribable drug, being a schedule 2 preparation, but there is no evidence that it is now being prescribed by doctors in any more than a small number of cases for other than genuine medical reasons. Until the early 1970s it could be prescribed by general practitioners, in the National Health Service or privately, for the treatment of heroin addiction. For the past 15 years that has not been allowed and it has been available only in specialised drug clinics. Whether that is the right policy is arguable, but there is no reason why the same prescribing restrictions should not apply to cannabis, which is not as highly addictive as heroin in any case.
The MRC states at page 144 of the evidence that:It is particularly important that the potential for new medicinal drug development raised by the likely existence of cannabis receptors is not stifled by considering all cannabis-like compounds as medically unacceptable because of the abuse potential of the natural product".695 Our report states in this regard at paragraph 8.17:As with any medicine which is open to abuse, safeguards must be put in place by the professional regulatory bodies to prevent diversion to improper purposes … These might include a system of declarations to be signed by the doctor and the patient".The committee is aware that, despite the considerable anecdotal evidence that was presented to it—and also described in the BMA's report of 1998—the scientific evidence for the effectiveness of cannabis to alleviate the symptoms of a number of conditions is still inadequate and further research is urgently needed. All noble Lords who have spoken have said that. The Government's opinion, however, is that this further research needs to be completed before they can consider altering the present status of cannabis. As many noble Lords have pointed out, that was the knee-jerk reaction of the Home Office.
May I make an aside at this point and ask why it is that the Home Office has the last word on this. When we are considering the therapeutic benefits of a possibly extremely valuable drug, the Home Office should at least consult with the Department of Health before making off-the-cuff statements like this.
However, the Home Office is to be congratulated on its relatively speedy granting of licences for the two important studies by Dr. Guy and the Royal Pharmaceutical Society. But, as many noble Lords have said, it will take at least five years before these trials are completed and fully assessed. Meanwhile, a number of patients—particularly those with multiple sclerosis—have found that cannabis leaf or resin is the only substance or medicine that gives them relief. They will continue to have to break the law while obtaining supplies of variable strength from irregular and illegal sources.
It is interesting to see how the committee, which included such distinguished scientists, reacted to the anecdotal evidence which was presented to it, both personally by actual sufferers and by doctors who described the experience of their patients. I can best illustrate the compelling nature of this evidence by quoting a little from a few cases. Perhaps I may start with a more lighthearted one. Dr. Robson, director of the drug dependence unit at the Warneford Hospital, Oxford, related the following anecdote. He said:two weekends ago I was playing golf with an 80 year old retired physician. We were held up on the twelfth tee and I was astonished when he took out of his pocket a battered tin and rolled himself up a cannabis cigarette. I said, 'What on earth is happening?' He said, 'I find it helps with my balance and coordination'. I really cannot comment except to say that he did beat me, so it certainly did not do him any harm".Someone who had a much more severe problem was Clare Hodges, Director of the Alliance for Cannabis Therapeutics. The gist of some of her testimony has already been quoted. She has had multiple sclerosis for 15 years, with spasticity, nausea, poor appetite and great discomfort in her bladder. For some nine years she 696 received no relief from a range of medication. When she smoked cannabis it was effective within about five minutes. She said:The tension in my bladder and spine melted away, and I felt less sick and stiff. I could move and generally function with greater ease and I slept soundly that night without medication".She had been getting up as many as 12 times to empty her bladder. What is more, she found smoking the cannabis leaf with herbal tobacco the best way to regulate the dose. Oral nabilone made her confused and clumsy and did not help her symptoms.
Many more examples were given to us. An interesting case was described by Dr. Fred Schon, a consultant neurologist and neuropharmacologist. His patient had a rare eye complication of multiple sclerosis called pendular nystagmus which was resistant to all standard treatments including nabilone. The patient reported a dramatic benefit from smoking cannabis which he said completely abolished his symptoms. In trying to replicate this with cannabis oil capsules, which was the only preparation Dr. Schon was allowed to prescribe by the Home Office, he obtained no benefit. He was unable to get a licence to study the beneficial effects of the smoked product.
When full chemical and pharmaceutical attention is focused on cannabis it may be possible to isolate the most effective cannabinoids in the most effective combination and to administer them by a less crude method than smoking and inhaling this semi-combusted product of cannabis leaf or resin. However, it appears that a significant number of patients with various degrees of neurological damage get remarkable relief from their unpleasant symptoms by inhaling that particular concoction of cannabinoids.
I share the belief of Dr. Robson, as I think do the other members of the committee, that compassionate reefers, despite the adverse effects of smoking itself, are fully justified if a patient has severe symptoms and is suffering from an illness, such as cancer or AIDS, which may shorten life in any case. But I would go further and suggest that these reefers or other preparations of smoked cannabis should be available on prescription on a named basis to patients with less immediately life threatening conditions. Of those, sufferers from multiple sclerosis will be much the most numerous.
§ The Earl of Strafford
My Lords, I congratulate the noble Lord, Lord Perry of Walton, and his committee on their landmark report and conclusions, which are both humane and pragmatic. Because of its illegal status, few chemical trials have been done on the medical use of cannabis, but there is a wealth of anecdotal evidence. Anyone who doubts that should read Marijuana—the Forbidden Medicine by Grinspoon and Bakalar, which makes compelling reading and charts the medical use of cannabis from its earliest mention, not on an Assyrian tablet but in a Chinese herbal 5,000 years ago, to its present-day use. Of special significance is the store placed on cannabis by the Victorians when it was introduced into modern western medicine in the mid-19th century. Between 1840 and 1900, more than 100 papers were written recording its therapeutic uses.
697 The heart of that book is an anthology of case histories of people suffering from severe or terminal illness who found that cannabis was the only substance that really helped. They were suffering from a variety of chronic conditions and there was a pattern of trying recommended drugs that did not work or, even if they did, produced unpleasant side effects. They turned to cannabis only as a last resort—sometimes with great reluctance and seldom with any expectations of improvement. Clearly their lives were transformed. Their physical and mental state improved and the quality of their lives was enhanced. Sometimes, it saved their lives.
The cumulative weight of evidence from those personal testimonies is compelling but all anecdotal—and here is the rub. Anecdotal evidence is considered substandard and is disallowed because it is not scientific. The phrase "anecdotal evidence" means personal experience and in this context it cannot be brushed aside. It is too extensive and authentic. Each case says, "Cannabis works for me". It can be argued that a good case history provides the smallest research study of all.
A classic example and an especially illuminating account of how one multiple sclerosis sufferer's life was transformed by cannabis is given by Clare Hodges to the Select Committee, as mentioned by the noble Lord, Lord Rea. As the Director of the Alliance for Cannabis Therapeutics, her organisation has received 200 letters from MS sufferers, giving detailed accounts of the benefits that they gain from its use. She also received 50 letters from people with spinal injuries and 20 with epilepsy, depression, arthritis, AIDS or cancer. Only five people responded who had either gained no benefit or suffered unwanted side effects.
Last year's BMA report, The Therapeutic Uses of Cannabis, was significant and reflected the frustration felt by a growing number of doctors because they could not prescribe cannabis to patients who might benefit, who were forced to break the law to obtain it. What has to be questioned is the BMA statement that,the information is meagre, but nevertheless it can be concluded that cannabis is unsuitable for medical use".Those who use it often in preference to the few cannabinoids available would disagree, and that point was commented on by Dr. Notcutt, with his work on nabilone, and by Clare Hodges. Using crude cannabis may not be ideal, but it works.
Eventually, the exact cannabinoids or combination of them that do benefit people will be unravelled, but that is at least five years away. Meanwhile, people who use cannabis remain criminals and often face a stark choice. A good example is the man crippled by rheumatoid arthritis who was registered as 97 on the arthritis severity scale. That rating dropped to seven after using cannabis. He said:My problem is that I don't want to flout the law deliberately. What can I do? Get better and break the law or feel worse?".The committee's recommendation that cannabis should be transferred from Schedule 1 to Schedule 2 and that doctors should be able to prescribe it to named patients, as they can morphine or amphetamine, would 698 give immediate help to people who need it and would make further research less complicated. That is also in line with public opinion. Polls have shown a clear majority in favour of medical legislation. That was highlighted a fortnight ago when AOL, the Internet service provider, organised an on-line survey asking, "Should cannabis be legalised to ease serious and terminal illness?". The result was a resounding 81 per cent. in favour and 19 per cent. against.
This issue is summed up for me by a letter written to the Independent on Sunday, which stated,I have multiple sclerosis and use cannabis to relieve unpleasant muscle spasms. It makes me very angry that I have to become a criminal to obtain and take this safe, cheap and very effective drug. Where is the sense?".I believe that the Government should take notice of these views and have the courage to implement the committee's recommendations.
§ 9.55 p.m.
§ Lord Clement-Jones
My Lords, this has been an extremely interesting debate. I particularly wish to thank my noble friend Lord Perry of Walton and his colleagues on the committee for a report that we on these Benches consider shows enormous humanity and good sense. As we have heard tonight from many members of the committee, the report examines with enormous care the evidence and the arguments for the medical use of cannabis.
As regards the medical benefits, the committee makes no bones about the fact that cannabis has quite a number of adverse effects. The committee has admitted that it has relied on anecdotal evidence. It seems clear that there is potentially a major role for cannabis to play in the care and treatment of MS sufferers, and that there may be other important uses—for example, the relief of pain of terminally ill patients, and for those undergoing chemotherapy.
As my noble friend Lord Perry of Walton made clear, the report concludes unanimously that, having balanced the risks with the benefits, the case is made out for clinical trials to be carried out with cannabis and its derivatives and analogues such as THC and nabinol, as the BMA suggested in its 1996 report. As we have heard, the report also—this is more controversial—concludes that cannabis should be moved from schedule 1 to schedule 2 of the dangerous drugs regulations. That would allow GPs to prescribe cannabis at their own risk for those such as MS sufferers who find it beneficial. In itself this recommendation goes further than the BMA was prepared to go in its evidence and in its original report, or indeed, subsequently in its response to the committee's report.
I say at once that I and my health spokesmen colleagues in the Commons back the committee's recommendations. I am particularly fortified in that view by the fact that one of our number, Dr. Peter Brand, MP, is a GP of many years' experience. He certainly believes that it is practicable to implement the recommendations of the committee. I am heartened also by the support of practitioners in this House—for example, the noble Lords, Lord Winston and Lord Rea—who also take that view.
699 The argument used by those who wish simply to wait for the results of clinical trials is, in my view, inhumane. They argue in summary that there are more than 60 cannabinoids in cannabis and it would be dangerous to allow cannabis to be prescribed until we know precisely which elements of cannabis cause the beneficial effects. The noble Lord, Lord Dixon-Smith, made an analogy with the lottery which I thought was particularly apposite. The fact is that such trials could take five years and more to identify those elements if one had to try all the different combinations.
There have been few trials to date, as we have heard. We have also heard about trials that are now in prospect. But shall we really see an upsurge of interest by the pharmaceutical companies when cannabis will still have the stigma of Schedule 1 status attached to it? Should we leave multiple sclerosis sufferers and others deprived for this period at a vital time of their lives, or do we in effect force them to become criminals? It is a cliché to say it, but it is nevertheless true that we all have only one life. Do we not have a duty to ensure that patients have as little suffering as possible? Are we really saying, after all this time, that we know so little about cannabis that we cannot risk terminal patients taking it rather than morphine, which we know is far more potent and addictive?
Pain management was a new science when my late wife was in terminal care 10 years ago. Now it is much more sophisticated. Do we think that palliative and terminal care doctors and nurses would behave irresponsibly? Would MS sufferers abuse the system? Is it not better that they should just simply have to produce a prescription if prosecuted rather than having to be taken to court and have the indignity of making a plea of mitigation? I do not accept what the noble Lord, Lord Mackenzie of Framwellgate, said. Why does he simply assume that because doctors may be prescribing cannabis for smoking, there will be abuse of the system?
I found the last paragraph of the evidence of the Multiple Sclerosis Society particularly poignant:The … Society does not encourage people with MS to break the law. We do however understand why some people who face intolerable symptoms have chosen to make their own decision about cannabis use, recognising the implications of their choice. Where the medical evidence warrants it, we hope that the police and the courts would deal with such people in an appropriately compassionate fashion".I do not believe that such a situation would be at all humane for MS sufferers. After all, what we are asking them to do is to throw themselves on the mercy of the courts.
We have heard that cannabis is not new on the medicinal scene. We believe that Queen Victoria used it, as my noble friend Lord Perry of Walton mentioned.
My Commons colleagues and I are particularly disappointed by the immediate negative response of the Minister Mr. Howarth, who with indecent haste indicated disagreement with the committee's report. Ministers should be quite clear about the precise recommendations of the committee. It is not saying that doctors should immediately be able to prescribe, but it 700 is saying that consultations—as is proper—should first take place with the Advisory Council on the Misuse of Drugs.
The committee also very clearly states that the medical profession should provide clear guidance on the prescription of cannabis. This would deal with aspects such as those suffering from schizophrenia. That is the sensible way forward, but it is not that being taken by the Government.
I believe that the Government's decision is less of a medical than a political decision. Medical considerations have become tangled up in the Government's mind with the recreational aspects which the committee was scrupulous in not getting confused. The Government appear to be terrified of appearing to be soft on drugs. They appear to be terrified of an adverse headline in the Daily Mail. As a result of the Government seeing the issue purely as one of law and order, a great many patients who could have benefited from cannabis to relieve their condition will suffer.
As regards the wider agenda and the recreational use of drugs, I note the committee's final conclusions. However, my party has strongly advocated for some years now the setting up of a Royal Commission which would provide a thoroughgoing investigation into the effects of drug use and misuse generally in this country. Such a Royal Commission could also examine the best ways in which to tackle the problem at its roots.
My party believes that that is the sensible way of dealing with the recreational aspects. which are entirely separate from the medical aspects. On the medical front, I very much hope that the Government will change their collective mind. Even if I had not been persuaded before this debate, I would be doubly persuaded now.
§ 10.3 p.m.
§ Lord McColl of Dulwich
My Lords, I too add my thanks to the noble Lord, Lord Perry of Walton, for presenting the report and for all the valuable work involved.
As a member of the medical profession for the past 40 years, I have always taken a particular interest in the care of those who are dying. In the past 13 years, I have been intimately involved in the Mildmay Mission Hospital, which was the first hospice in Europe devoted to the care of men, women and children dying of AIDS.
I have never had any problem in seeing my task as relieving distress, whether that distress was pain, nausea, respiratory distress, anxiety, depression or whatever. Nowadays that is a much more precise practice as we have a host of different drugs to deal specifically with each symptom, rather than showering them with crude compounds containing scores of different chemicals of unknown quantity and unknown effects.
With chronic incurable diseases of all kinds, the search continues for more precise drugs which can deal with a variety of symptoms. But the medical use of cannabis in Europe and North America has declined this century, first, because there is no standardised preparation of cannabis and, secondly. because of its unreliable absorption when taken by mouth.
701 Cannabis has a very complex structure and even for a given strength produces irregular, widely varying, and thus unreliable, results. That is why it was ejected from the British Pharmacopoeia in 1932; its dismissal was in no way related to its legal status on the street, its so-called recreational use.
We support the committee's view that evidence-based findings fully justified the rejection of the recreational use of cannabis and that its present controlled status should be maintained. We also fully support the committee's recommendation that there is a great need for scientifically rigorous trials, and that the notion of smokable medicines should continue to be rejected.
In referring to the smoking of cannabis, the noble Lord, Lord Perry of Walton, might have emphasised that smoking cannabis is even more dangerous than smoking ordinary cigarettes because it contains a greater concentration of cancer producing substances. It results in a five-fold greater increase in carboxyhaemoglobin concentration, which makes that haemoglobin molecule less available to carry ordinary oxygen, and that places an additional burden on the heart; and, as the noble Lord, Lord Mackenzie of Framwellgate, mentioned, a three-fold greater increase in the amount of tar inhaled. Also, it leads to retention in the respiratory tract of one-third more tar than the smoking of ordinary cigarettes.
Controlled clinical trials are difficult when one is comparing the smoking of cannabis with something else. It is difficult to find a suitable placebo.
One of the cannabinoids, nabilone, was licensed as a drug to help control the nausea and vomiting produced by chemotherapy in cancer patients. Apparently it is not much used for that purpose because it is not nearly so good as the new and more powerful anti-nausea drugs such as ondansetron and others with names that are difficult to pronounce. The other advantage of these compounds is that they can be given intravenously, which is useful for patients who are vomiting.
The committee has argued that it "received enough anecdotal evidence" to convince it of the medical value of cannabis, although it concedes that "there is not enough rigorous scientific evidence". The committee says its "principal reason is compassionate". I am not sure that it is really compassionate to expose sick people to unproven drugs with psychoactive side effects; there are approved protocols for the introduction of drugs, and even then mistakes are made and problems arise. The only people likely to benefit would be the legal profession, advancing claims for damage by this improperly approved compound.
When we examine the anecdotal evidence, it consists largely of people who have smoked cannabis saying that they prefer smoking it to having it in other forms. First, I think we should remind ourselves that the word "anecdote" means in Greek "not published", which is arguably what most anecdotes should remain. Secondly, I remember well patients telling me in the 1950s that they much preferred digitalis leaf to the new-fangled preparation digoxin. They said that the leaf, which we prescribed in grains, as I think my former tutor, my noble friend Lord Butterfield, will confirm, was much 702 more effective than the pure digoxin. The truth of the matter is that the amount of pure digoxin in each digitalis leaf varied a great deal. In fact, it is thoroughly bad medicine to use that preparation.
I work on the principle that the customer is always right, but sometimes he is not right, and in this case he is quite wrong. After all, only 1 per cent. of people suffering from multiple sclerosis are believed to use cannabis, so it cannot be described as a "widespread experience". Further anecdotal evidence is that cannabinoids are not as good as crude cannabis because they do not make the patient "high".
It is the job of the Opposition to oppose the Government over policies that it thinks are wrong but to support them over policies it thinks are right. We on these Benches agree with the Government that cannabis should not be rescheduled to allow doctors to prescribe it until the safety, quality and efficacy of a medicinal form have been established by rigorous scientific means and until the Medicines Control Agency issues a marketing authorisation.
We fully support the stand taken by the British Medical Association. I think it is worth saying that the BMA today is more helpful and constructive than I have ever known it. The BMA summarises this situation well when it says:Cannabis contains over 400 chemical compounds including more than 60 cannabinoids, with considerable variation in the concentration present in different preparations".Even if cannabis were shown to have therapeutic benefits, it would not be possible to know which particular agents were beneficial and medical knowledge would not be advanced or treatment improved. For those reasons, as well as because of the known toxic constituents in cannabis smoke, the BMA consider that cannabis is unsuitable for medical use. They say that such use should be confined to known doses of pure or synthetic cannabinoids. We agree with that.
I should like to emphasise a point made by the Under-Secretary of State at the Home Office in January 1997 when he said that many of those calling for the medical use of cannabis are using it as a stalking horse to promote the campaign for its legalisation. The noble Lord, Lord Mackenzie, mentioned that point.
Paul Boateng, the Health Minister, said that we should not accept a lesser standard of evidence in the case of cannabis because of pressures on behalf of people who are convinced of its therapeutic value.
It is worth stating that in the United States organised campaigns to legalise cannabis have usually started by launching a debate on its medical uses. There are, of course, many sincere people who advocate the use of cannabis for medical purposes and whose only concern is to alleviate suffering. But many believe that the efforts of these sincere people are being cynically deployed by other groups seeking legislation. These groups are well aware of the propaganda value in gaining ground in the medical cannabis debate.
703 Another disadvantage of legalising the use of cannabis for medical reasons is that the United Kingdom would then find itself out of step with many other countries. In this field I do not think we should be pioneering in that way.
In conclusion, I again thank the committee for this valuable report which has highlighted the difficulties of the subject. I very much hope that the Government will support the plea of the committee for more rigorous and scientific research in this field.
§ Lord Rea
My Lords, before the noble Lord sits down, he said that at the moment only I per cent. of multiple sclerosis sufferers used cannabis. However, according to the Multiple Sclerosis Society—I look at page 84 of the report—there are 85,000, sufferers which means that 850 of them now use cannabis. That is probably a minimum figure because there are many who can benefit from it. A lot of people might well use it if it were legal.
§ Lord McColl of Dulwich
My Lords, I entirely agree. I read the report and the figure is 1 per cent.
§ 10.16 p.m.
§ Lord Hoyle
My Lords, I start by congratulating the noble Lord, Lord Perry of Walton, and the Select Committee on Science and Technology on producing a very interesting report on cannabis. No one who has listened to the debate this evening can fail to be impressed by the findings of the committee.
I congratulate the noble Earl, Lord Carrick, on his excellent maiden speech which was listened to with interest and attention. I hope that it will not be too long before we hear from him again.
The Government must examine the scientific and medical evidence to see whether there is a case for relaxing some of the current restrictions on the medical uses of cannabis and to consider whether the prohibition on the recreational use of this drug is justified on the scientific evidence of adverse effects.
There is a huge volume of literature on cannabis. I believe that the committee has done exceptionally well in refining all of this material and producing a readable report. However, the purpose of this debate is not to provide the Government's full response to the committee's report because these proceedings take place before the Government have replied to the report. But all of the contributions that have been made today by noble Lords will be taken into account by the Government in their reply. In that respect. I believe that the purpose is a very useful one.
We are all aware that, according to convention, the Government reply to the reports of Select Committees within two months. However, as has been mentioned in the debate the committee made a recommendation that the Advisory Council on the Misuse of Drugs which advises the Government under the Misuse of Drugs 704 Act 1971 should be consulted before they responded to the report. It was recognised by the committee that this might take a little time. As the noble Lord, Lord Perry of Walton, said in opening the debate, the committee is prepared to wait longer for a reply.
The council meets twice a year but it had a meeting on 19th November. Therefore, it was possible for the council at that meeting to consider the report briefly. One of the general comments that has been made is that the Government should not have responded so quickly. While it may not be the general custom to respond immediately to the Select Committee's report—I do not believe that anyone questions that—it is acceptable for the Government to do so. They do so in this case because the Government have a clearly established and logical position on the medical uses of cannabis. That is a position from which they would be willing to move only—I stress this—if scientific evidence to support the change were available. That evidence is not available, and indeed the report admits as much in paragraph 8.1. In those circumstances the Government thought that it was better to remind everyone of their position and the reason for it rather than to leave a gap, because that gap might have created the impression that we thought a case for change had been made.
It was against this background that the advisory council, in view of the Government's position, took the view that cannabis should not be rescheduled. If the time comes when a cannabis-based medicine has been developed the advisory council will, under the terms of the Misuse of Drugs Act 1971, have to be consulted before any change is made to the legislation.
As I have said, this debate is not the occasion when the Government are giving their full reply to the report, but at this stage I would like to reiterate what the Government said about some of the recommendations after the report was published. The last words in the main report are that the committee recommends that:cannabis and its derivatives should continue to be controlled drugs".In making the recommendation, the committee referred to a statement by the United Kingdom Anti-Drugs Co-ordinator in the Government's White Paper, Tackling Drugs to Build a Better Britain. Mr. Hellawell said that:the more evidence that becomes available about the risks of, for example, cannabis and ecstasy the more discredited the notion that any of the substances currently controlled under the 1971 Act are harmless".This is something that the Government have always believed, and we believe that the committee's recommendation supports our position. We believe that the general legalisation of cannabis would be a serious mistake, and indeed we heard tonight a very powerful speech from my noble friend Lord Mackenzie of Framwellgate pointing out the dangers that could arise from legalisation. We are not prepared to be a party to making any mistake in that regard.
The Government also welcomed the committee's recommendation that more work is needed on the possible medical benefits of cannabis. However, the 705 Government found themselves unable to agree—I say this to the members of the committee—with the recommendation that:steps should be taken to transfer cannabis and cannabis resin from Schedule 1 to the Misuse of Drugs Regulations to Schedule 2 so as to allow doctors to prescribe an appropriate preparation of cannabis, albeit as an unlicensed medicine and on a named patient basis and to allow doctors and pharmacists to supply the drug prescribed".Put another way, we believe the recommendation is that doctors should be allowed to prescribe cannabis: that is what we believe is being said by the committee. Where it is not explicit about what is meant by "an appropriate preparation of cannabis" the Government have assumed that this could, in the committee's view—and we have discussed this tonight—include smoked cannabis, despite the acknowledged dangers of that form of administration. I can see the noble Lord, Lord Perry, is agreeing with me in that.
In principle, the Government have no difficulty with the proposal of a cannabis-based medicine or medicines containing individual cannabinoids. However, we do not agree that any prospective medicines which contain these substances should set aside the standards required of prospective medicines. The case for that was made very clear by the noble Lord, Lord McColl, speaking from the Opposition Front Bench. These standards are that the quality, safety and efficacy of the medicine have to be scientifically proven. There are good reasons for having those standards. I do not need to say this because all noble Lords who spoke tonight—many of them expert in their fields—are aware that it is necessary to ensure that inferior quality, unsafe or ineffective medicines are not prescribed to patients. I think that we can all agree on that.
The committee also acknowledged that there was not enough scientific evidence to prove conclusively that cannabis has or has no medical value of any kind. Nonetheless, we get back to the anecdotal evidence that cannabis almost certainly has a genuine medical application, in particular for the treatment of muscular spasms and symptoms of multiple sclerosis and the control of other forms of pain. Much has been said on compassionate grounds. The Government are not unsympathetic. No one could ignore the plight of these people. If they cannot be helped by existing medication, should we look to cannabis to help them? Sufferers of certain ailments might be able to obtain relief lawfully by using cannabis. However the development and licensing of medicinal forms might take five years. Although the Government have enormous sympathy for those patients whose conditions do not respond to existing treatment, and we understand why the committee has reached its view, we do not believe—and I think that many people would agree with us—that an exception should be made for cannabis.
We believe that one of the consequences of accepting the recommendation would be to undermine research into medicinal forms. We believe that a good deal of the incentive would be swept away if crude cannabis was prescribable. That view was also shared from the Opposition Bench.
706 However, we are making progress on research into cannabinoids. The Medical Research Council (MRC) the main agency through which the Government support medical and clinical research, has awarded a grant to Dr. Kendall of the University of Nottingham to undertake two studies. While those studies do not directly address the value of the therapeutic use of cannabis, they could prove important in informing any further, more applied research.
§ Lord Winston
My Lords, I am grateful to my noble friend for giving way. I apologise for the lateness of the hour. Those studies do not address the therapeutic issues. Does the Minister agree that the current regulatory framework is a Catch-22 situation? It prevents any controlled study of the type that we feel would be appropriate. One cannot gain the evidence without undertaking the studies; and the current regulations prevent scientists and funding authorities from supporting such studies, so there is a real problem intellectually.
§ Lord Hoyle
My Lords, my noble friend spoke about a Catch-22 situation. He says that the studies would not directly address the therapeutic use. We believe that they could be informative. However, as has been said throughout, we are in favour of more clinical studies taking place. Perhaps I may say to my noble friend that we have to overcome that Catch-22 situation.
The final reports will be submitted to the council in due course, and Dr. Kendall will be expected to publish his findings in the scientific press in the usual manner. In addition, the Medical Research Council is committed to an evaluation of the therapeutic use of cannabis by clinical trial and is working closely with the Royal Pharmaceutical Society to enable research in that area to be put on a better scientific footing.
However, the Government are not alone in believing that crude cannabis should not be made available. As has been said this evening, that position is supported by the BMA. In addition, the Royal Society has said that there is not enough evidence to justify either a ban on or the legalisation of cannabis for medical use and that proper clinical trials are necessary before reaching conclusions.
I believe that this debate has been invaluable because not only have we had the benefit of the opinions of all the committee members but it has also provided an opportunity to look at the committee's report. The Government will provide a full reply in due course and we shall also study what has been said during this debate.
In conclusion, I thank all noble Lords who have taken part this evening. In particular, I thank all the committee members and especially the chairman of the committee. It is quite apparent from what I have said that we feel unable to agree with one of the report's central recommendations. However, there is no doubt about the value of the report, which has been acknowledged on all sides of the House. The report will be valuable in the future in relation to the study of cannabis and it will 707 help to inform debates which surround the use of cannabis. We are extremely grateful to the committee and this has been a very useful debate indeed.
§ 10.31 p.m.
§ Lord Perry of Walton
My Lords, I too thank all those who have taken part in the debate this evening. In particular, I thank the noble Earl, Lord Carrick, who made a splendid maiden speech.
I have only three points that I want to make, because it is late. First, as the Minister said, moving cannabis into Schedule 2 would undoubtedly allow doctors to prescribe it for smoking. Indeed, they could prescribe it in any way they liked because moving it to Schedule 2 allows them to do that. As I said in opening the debate, we do not believe that that is quite as bad as it sounds because—and this is my second point—I am quite hopeful that the clinical trials which are about to take place will be successful. I believe that they will be successful both for the cannabinoid that is being used 708 and for the crude cannabis that is also being used in a standardised preparation. It will probably be made by cloning the plants so that at least the content will be the same. If it is successful, that will lead to a licensed product which has the approval of the Medicines Control Agency.
My third point relates to what the noble Lord, Lord Mackenzie, said. If that happens, it will create precisely the same difficulties as those the noble Lord outlined. They will still arise. It is illogical to assume that putting cannabis into Schedule 2 will be more dangerous than licensing the product in terms of spreading the level of abuse of the drug. I do not believe that in either case, there would be that spread of abuse which has been referred to. I believe that most doctors are responsible and the medical professional bodies would take good care of those who transgressed. I commend the Motion to the House.
§ On Question, Motion agreed to.
§ House adjourned at twenty six minutes before eleven o'clock.