"I am not against any drug that is useful. As long as it has been through the clinical trials."
This article was originally written for a university module assignment in 2018. Facts, numbers and legal proceedings stated in the article may have changed since.
At King’s College Hospital, a group of volunteers are walking down the corridors to the hospital shop. Their goal is to buy and item, and come back. The catch? They’re all high as a kite.
“Essentially you can turn any compound into a medicine if you do studies and show that it is effective for a certain condition,” says Dr Amir Englund, researcher at King’s College Institute of Psychiatry, Psychology and Neuroscience (IoPPN). Any compound? He quite possibly just lifted the lid on Pandora’s box.
Dr Englund is part of a research group looking into the effects of cannabis on the brain. As a bill to legalise cannabis for medicinal use is making its way through its second reading in the House of Commons, the timing is perfect.
Since the 1920s, cannabis has been illegal in the UK. And since 2009, it has been classed as a Class B drug under the 1971 Misuse of Drugs Act, meaning that “it has no medicinal properties” whatsoever. The classification has received much scrutiny from both politicians and pro-medicinal cannabis activist, who say the act is inconsistent in its classification of drugs and that the British Government is too conservative in its approach to coupling the UK’s growing drugs crisis. In 2009, when the then chairman of the Advisory Council on the Misuse of Drugs, Professor David Nutt, suggested that cannabis according to some studies causes less harm than alcohol and tobacco, he was dismissed from his position.
The controversy around cannabis relates to the UK’s paradoxical drugs legislations. Whilst some drugs are deemed illegal under one act, they may be legal under another. Morphine is an illegal Class A drug under the 1971 Misuse of Drugs Act due to its properties as an opiate. Yet, under the Regulation Act from 2001, it is classed as a Schedule 2 Controlled Drug, allowing for doctors to administer morphine as a painkiller to patients under prescription. Cannabis, it has been suggested, should enjoy the same duality.
“Smoking is the least medicinal way to take cannabis,” says Paul Hussey, 49, a recovering cancer patient and keen medicinal cannabis activist. In 2014, while living in South Africa, Paul was misdiagnosed with tuberculosis. For three months, as tumours rapidly covered his body and his organs began to shut down, he waited in excruciating pain for a biopsy to determine the real cause; stage IV lymphoma. In the nick of time, he was flown back to the UK and started on chemo.
“I give allopathic medicine its due,” says Paul. “Because it kept me alive. And that’s what conventional medicine is so good at,” he adds. Paul lives in Bromley, works two jobs, and is a busy family man. Last year, he ran three marathons in less than five months. Hard to imagine that just 3.5 years earlier, cachexia had nearly eaten him away. “It wasn’t like a near-death experience where you experience it in an instant,” he says and snaps his fingers. “It was like near-death awareness.” As soon as Paul finished his six cycles of chemo, he began taking cannabis oil. His personal preference is to squeeze it onto a cream cracker in the morning.
The case of medicinal cannabis should be a simple matter of scientifically proving its medicinal properties. But science is never a simple matter.
“We don’t get painkillers from poppies,” says David Raynes of the National Drugs Prevention Alliance. Raynes has been active in the debate on drugs since the late 60s, and in his job working for Customs and Excise tackling drug smuggling. But he is far from any sceptic anti-drug campaigner you’ve met before. “I am not against any drug that is useful,” says Raynes. “As long as it has been through the clinical trials.” David’s arguments is that natural cannabis is far too unstable to become a medicine.
And Dr Englund agrees. “Cannabis is not one thing,” he says. “So far, we known of 144 different cannabis compounds in the plant, and each of them has a different effect.” Because of this, the level needed to prescribe cannabis on the NHS is very hard to reach.
Each of the 12 volunteers taking part in the first set of a range of experiments at King’s College, have been administered a varying dose of cannabis which is reacting with their endocannabinoid system (our body’s own cannabinoid-producing system). Some of the volunteers are only experiencing the effects of tetrahydrocannabinol, or THC, which is one of the most common cannabinoids found in cannabis, known to have an intoxicating effect. For others, cannabidiol (CBD) which has a calming effect, has been added in doses varying from 1:1, two to 1 and three to one. Street-cannabis, in particularly ‘skunk’ is known to have high levels of THC, which has been linked to the harms associated with cannabis use, like anxiety, paranoia and addiction.
“In some of our previous studies, CBD has shown to counteract some of these effects,” Dr Englund explains. Different cannabinoids react differently with our endocannabinoid receptors, and both THC and CBD have the ability to complement and knock each other out. The goal of Dr Englund’s research is to find out how. Previous studies at King’s College have shown that certain activities (like buying snacks at the university kiosk) can cause anxiety and paranoia. “We want to see how much CBD needs to be added to THC in order to make the experience of taking cannabis safer,” Dr Englund explains. This, however, takes time and money, throwing publicly funded research institutions like King’s College into a race against the financial powerhouses of the UK’s booming medicinal industry.
"Smoking is the least medicinal way to take cannabis."
Since, 2010 cannabis has in fact been available medicinally, albeit in a restricted form. Sativex, a 1:1 THC and CBD medicinal mouth spray was produced by GW Pharmaceuticals, and approved as a prescription drug for treatment of pain and spasticity in multiple scleroses patients. Sativex could be seen as the first successful step towards legalising cannabis medicinally. But it’s been heavily criticised for being too expensive compared to what it offers patients. As such, Sativex paints a rather eerie picture of the power of money in the face of drugs legislation. “The way that [Sativex] had been proven was that the company had invested money in developing this product and running many, many large-scale studies to show that it is effective,” says Dr Englund. But GW is an exception, since most private pharmaceutical companies would rarely invest money into something they cannot patent. And since cannabis and its molecules is a natural product, there is no monopoly on its usage. As such, it is often down to universities to conduct these studies, where money is much sparser. “We can’t fully say that cannabis is a medicine because we need to do more studies,” says Dr Englund. “But we can’t do the studies because there’s not enough funding.” It’s a bit of a catch-22 situation. And it’s causing much frustration for patients desperate for new alternatives.
“The Government, we elect them, but the corporations have all the say,” Paul beliefs. “This lobbying system is very corrupt. The fact that cigarettes and alcohol companies can determine policy, pharmaceutical companies can keep cannabis at bay…how is that?”
According to Labour MP Paul Flynn, who proposed the bill legalise medicinal cannabis, “the law is at fault.”
“The problem is, the law is telling people that either you miss out on your medicine of choice or you criminalise yourself,” says Flynn. “At the moment, we have the worst system, where we have cannabis taken in its most dangerous form with tobacco, and the market is in the control of irresponsible criminals,” he argues. According to him, the prohibition of drugs has been as successful as the prohibition on alcohol in 1930s America.
Paul Hussey agrees with him. “A lot of people are drinking alcohol, most people have at least one in their extended family who can’t handle liquor and it’s a problem,” argues Paul. “We don’t ban all alcohol just because they can’t do it sensibly.” When done in the least harmful way, Paul argues, cannabis usage can open the mind to self-healing and creativity, something he calls the ‘spring effect’. “You hit the spring, make it go down, and then you release it,” he explains. “If you release the spring,” says Paul, “it means you are clear and can put all those great ideas into action. But if the spring is down all the time, it is a completely dulling effect,” he argues - and a straight path to addiction.
Paul strongly believes that once cannabis is legalised, people can start to be educated about its effects properly. “We need to give the information, good and bad. And from there on, if they chose to do it every day and ‘wake and bake’, then that’s their choice,” he says. “They have an informed decision, just in the same way as cigarette smokers have.”
But Dr Englund is a bit more sceptical. He argues that the potential increase or decrease of harm is not so much a question of if you legalise it, but how you legalise it. “If you allow all forms of advertisement in every shop, on every corner and you put out adds saying ‘2-4-1, buy on discount’…those things are more likely to get more people to buy, and is more related to harm,” Dr Englund says. And although countries like Holland, Canada and the States have partially legalised cannabis usage, different market restrictions apply, making it hard for the UK to make a proper comparison of cost and effect.
On an individual level, Paul admits he can only speak from personal experience. And he understands scientists getting annoyed when naturalists label cannabis the ‘miracle cure’. “But we must also get annoyed with scientist saying that science is the answer to everything, because you will never get a miracle pill either,” says Paul, arguing that the human being is complex. “We need science - but we also need natural.”
But without control of production, ‘natural’ may not be safe. In the US, labs like ProVerde in Massachusetts has been set up to test medicinal cannabis brands for harmful substances such as pesticides and heavy metals. If the UK introduced the same kind of strictly regulated medicinal cannabis market, it could reduce harms by controlling production. Dr Englund proposes that the most efficient system would be one with restriction similar to those imposed on alcohol, i.e. taxation, laws in regard to who can sell or buy, and a ban on advertisement. “If you ban advertisement you see a drop in manic use,” he argues.
“Cannabis is like any other drug,” Dr Englund continues. “The harms are relative to its use and the person’s vulnerability.” Studies conducted both at King’s College and Imperial College, London have shown that people with schizophrenia are more likely to be vulnerable to the negative effects of THC-potent cannabis, such as psychotic symptoms. But studies also revealed that their mental condition had no effect on usage in itself. “Our studies showed that people with schizophrenia take it for the same reason as healthy people, to relax and enjoy a pleasant intoxicating experience,” says Dr Englund. He therefor believes that changing the law won’t have a great impact on who does and does not use cannabis.
"Cannabis is like any other drug. The harms are relative to its use and the person’s vulnerability"
Paul agrees. Legalisation or prohibition, he is still going to spread cannabis oil on his cream crackers in the morning. And he believes more and more are following his example. “The demand is incredible from all sorts of people with all sorts of illnesses, they all want to try it because they are desperate for alternative,” he says. Figures from the European Drug Report 2017 show that overall drug use has declined in UK over the past decade, but cannabis remains the most popular drug. An evidence of its popularity is the event known as ‘four-twenty’ taking place every year on April 20th around the globe. In London, thousands gather in Hyde Park at 4:20pm to support free access to cannabis. As the smoke clouds fade away, people return back to their normal lives as office workers, students, and even parents, in the same way one would return home from the pub. “You cannot try to turn back the tide,” says Paul Hussey. “The tide has turned and we got to keep pushing.”
But there are still many steps to take before medicinal cannabis will sit on the shelf at the local drug store. And that is why Dr Englund and other researchers at King’s College continue to get people high in. Because when the time comes for cannabis to be presented in the House, science must present the evidence, whether it speaks for or against legalisation.