OUT ON A LIMB OVER BENEFICIAL JOINTS

Sarah Boseley on the radical nature of the Lords committee's recommendation
that doctors should be able to prescribe cannabis

Scientific evidence that cannabis relieves the pain of multiple sclerosis
sufferers and others does not exist. The House of Lords select committee on
science and technology admits this in its report, published this morning.

That is why it is extraordinary that the committee, as an independent group
made up mostly of scientists, wants doctors to be allowed to prescribe
cannabis to patients.

The report is radical and represents a big departure from the position of
the British Medical Association, which backed trials of cannabinoids -
derivatives of the cannabis plant - last year but is firmly opposed to the
use of cannabis itself, which it says is full of toxins. But multiple
sclerosis and cancer patients who smoke dope because it relieves the pain,
and - in MS - reduces spasms, say that the cannabinoids in tablet form so
far developed do not have anything like the swift and effective impact of
the real thing, smoked in a joint.

The committee believes them, and feels it is wrong that those in pain
should have to break the law and that their doctors should be under
pressure to connive with them. The committee says that its recommendation
is not scientific, but compassionate.

Medical use of cannabis was only made illegal in this country in 1973.
Before that, as the peers point out, "it has been used medically for
thousands of years in oriental and Middle Eastern countries". Nobody has
been killed by cannabis, which is generally accepted to be less toxic than
alcohol.

The committee states that "in all the evidence we have received, there is
not enough rigorous scientific evidence to prove conclusively that cannabis
itself has, or indeed has not, medical value of any kind." Members had been
convinced not by scientific proof, but by "anecdotal evidence".

They want cannabis to be made available legally to patients and quickly.
That desire has put them in a difficult position. No standardised plant
extract has yet been produced - as users know, batch strengths on the
street vary enormously - and no effective way of taking it other than
smoking, which the peers do not want to endorse, has been developed.

They have taken the only logical route towards their goal. They have
suggested, in effect, that doctors should write out a prescription for the
patient to pick up his resin and his Rizlas at the local pharmacy.

The Royal Pharmaceutical Society, which is about to start clinical trials,
agrees with the committee - in fact, they say, they said it first.

The RPS would like to see doctors allowed to prescribe cannabis, but they
point out that pharmacies would not be supplying the sort of cannabis that
is smuggled in the soles of people's shoes from Morocco or traded in cafes
in Amsterdam.

If cannabis were moved from schedule 1, where it ranks as an illegal drug
of abuse with no therapeutic use, to schedule 2, to become a controlled
drug which can be prescribed under some circumstances, manufacturers would
be able to produce and supply to chemists a standardised product.

Tony Moffat, the RPS's chief scientist, says the society believes the way
ahead lies in cannabinoids - the active ingredients - rather than the whole
plant, which he describes as "a pharmacologically dirty substance. When you
ingest cannabis you take in hundreds of compounds, some of which may do
harm and some of which may be helpful. What we need to do is isolate the
useful cannabinoids and that is why we need more research."

But the two-year clinical trials, to be launched in January, will examine
both. Groups of volunteers, probably with MS, will take either the
cannabinoid THC, which scientists think is responsible for the drug's
pain-relieving effects, or an extract of the whole plant, or a placebo.

The results could be crucial. At the moment, most European countries take
the line of the World Health Organisation that cannabis has no therapeutic
value and is only a drug of abuse. Under a WHO convention, Europe agrees to
ban its use by doctors. But if the RPS trials prove there is therapeutic
use, then the WHO line will probably change and the way will be open for
medicinal use everywhere.

The peers think Britain should not wait. "We consider that the Government
should not be afraid to give a lead in this matter in a responsible way,"
says the report. But they also urge that the clinical trials should get
going as fast as possible.

While they suggest that smoking cannabis would be acceptable for the time
being in patients who need immediate pain relief, they say that this is not
satisfactory in the long run. They recommend research into other ways of
taking it, such as inhalation, "which would retain the benefit of rapid
absorption offered by smoking, without the adverse effects".

Unfortunately, cannabis taken orally is degraded by the liver before much
of it can reach the brain, where it has its effects.

According to the UK Alliance for Cannabis Therapeutics, the drug is
probably used by several hundred people suffering from MS, although they
may amount to no more than 1 per cent of those with the disease. Others who
use it have spinal injuries, back pain, chronic arthritis, epilepsy and ME.
The cannabinoids Nabilone and Dronabil are prescribed by some doctors for
the nausea that follows chemotherapy for cancer. But ACT believes more
people in this category smoke cannabis itself.

Checked-by: Mike Gogulski