Medical Cannabis was made legal in the UK in 2018 but it remains unavailable to the majority of patients who are not able to afford a private prescription.
Pharmaceutical Industry Lobbyists court MPs for exclusive and lucrative licenses. Meanwhile the police are still kicking down doors of modest home-grows and even confiscating legal weed; what is going on in the UK?
In this episode of The Hemp Community Podcast we discuss the role of inequality and economic deprivation on healthcare outcomes with particular reference to the mishandling of medical cannabis policy.
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Episode 14 – Cannabis and Healthcare Inequality
Hi there and welcome to the hemp community podcast, my name is Dan and in today’s episode we’re going to be discussing cannabis and how it relates to healthcare inequality.
For those of you who may not be familiar, the hemp community is a social enterprise that specialises in the sale of legal cannabis products. We also offer advice and support for individuals and families who want to use our products for their health. Although not entirely related to the business, in my spare time I am working towards a Masters degree in Public Health, and my area of interest is how cannabis can be used as a tool to improve the health and wellbeing of the population, not just those who happen upon our business.
The key word in that last sentence was “population”. When we talk about public health, we aren’t just talking about tallying up the instances of disease observed in individuals; public health practitioners are generalists who combine a number if techniques to both treat and prevent disease. In this instance the word “disease” refers to any ailment or condition, whether it be a minor ailment or a life changing condition. One of the most famous public health interventions was conducted by a physician called John Snow in the 19th century. He investigated outbreaks of cholera in Victorian London, and joined the dots to show that the spread of the disease was linked to hygiene practices at specific water treatment facilities that supplied different parts of the city. After the publication of his findings, and the subsequent corrections to the civil infrastructure, the epidemic of cholera was halted and the threat future disease was greatly reduced.
During the course of the 20th century new advances in medicine and science allowed for better data collection and analysis, which in turn led to better interventions and ultimately outcomes. For the majority of human history, infectious diseases posed the greatest threat to our survival, but with the advent of public health practices the burden of these diseases has been minimised. Vaccination is a good example of a population level intervention that has been show to prevent transmissible diseases. In developed nations like the UK, the reduction in infectious disease has seen an increase in average lifespan. The unfortunate downside of this is that though many people are living longer lives they are also having to live with chronic diseases that are often associated with lifestyle, environment and occupation.
It is an unfortunate but inevitable truth that people with access to more resources will be better equipped to manage and live with chronic illness. Doctors in the west are able to provide a higher level of care than clinicians working in developing countries. Similarly, physicians who work in the private sector have even more time and resources to dedicate to individual patients. In the UK most of us rely on the National Health Service for our medical care; socialised medicine free at the point of need and paid for by contributions in the form of National Insurance automatically deducted from wages and salaries.
It's easy to forget that we all pay for the NHS; each according to their ability to contribute. The service was born out of the chaos of WW2 and indeed it is something that everyone in Britain shares a common pride int; our NHS. Most of us are not used to the idea of paying for medical care, and indeed I suspect the majority of Britons would scarcely be able to afford said care without the safety net of the NHS. In a sense the NHS levels the playing field, rich and poor alike will require the attention of a doctor at some point, but this is where the subject of today’s podcast comes in. Healthcare inequality is a subject that has garnered more and more attention over the last few decades; in the way that infectious disease epidemiology yielded to occupational/environmental health in the 20th century, here in the opening years of the 21st century it seems the next big leap for public health will be in in addressing inequality as a means of improving the health and wellbeing of the population. I believe that healthcare inequality is especially evident in debacle surrounding medical cannabis in the UK.
For reference, the first British doctor to use cannabis in his practice did so in the 1830’s; William Brook O’Shaugnessy studied the effects of cannabis oil on infants with epilepsy, finding that their seizures were controlled by the substance and without harm to the child. UK doctors were able to, and frequently did prescribe cannabis oil up until the Misuse of Substances Act (1971) came along and removed the plant from the medicine cabinet. In 2018 the Home Office amended legislation to allow medical cannabis once more, and since then everything has been just peachy….right?
Unfortunately not…and let me be quite honest at this point; I am quite cynical about the UK’s tenuous embrace of cannabis medicine. Of course I am delighted that thousands of people up and down the UK are able to access legal medical cannabis, but for reasons that we will shortly discuss, I think that our government have done a poor job thus far, and to add insult to injury I believe they have done so deliberately, blinded by greed.
First of all we need to understand that healthcare inequality is complex; people on low incomes tend to have more stressful lives, live in less comfortable environments, often have less access to quality food, are more likely to have lower levels of educational attainment, and are more likely to use alcohol and tobacco. There are number of determinants that can contribute to an individual or community’s health status, but from a distance what we can observe is that people on higher incomes are more likely to have better health and visa versa. In a sense, money, be it in the form of inherited wealth or a generous salary, is able to provide a buffer against the conditions that lead to illness and disease. Such is life, we are told. Many of the most frequent visitors to NHS facilities are people from the lower end of the socio-economic spectrum, and often they are being treated for preventable conditions. One of the unusual downsides of socialised medicine is that as a society we lose contact with the cost of medicine. Every few years a life-science company, or so-called “pharma-bro” will purchase a medicine and ramp up the price to the point of public outcry. The most famous example was a man by the name of Martin Shkreli whose company bought the rights to a drug called “daraprim” and went on to increase the price from $13.50 per pill, to $750 per pill. This is of course an extreme example but it illustrates the point that life is not only precious but valuable, and those with access to resources will be always be able to find a way to afford their essential medicines.
For many millions of people around the world Cannabis is an essential medicine. In fact for many cannabis users, cannabis is their only medicine; one that is able to treat and prevent a number of diseases and their symptoms. Cannabis is a dioecious flowering herb that produces a bouquet of compounds called “cannabinoids”. Cannabinoids are not unique to the cannabis plant, but it is uniquely good at producing them. When humans consume cannabis, we are topping up our own endocannabinoid system with chemical messengers that can be used to promote the function of that system. A healthy endocannabinoid system makes for a happy healthy individual, and in a nutshell that’s how medical cannabis works; we give our bodies the tools it needs to facilitate its own maintenance. And as if all this wasn’t good enough, and just in case I needed to remind anyone, cannabis is a plant; it grows in the dirt and even a novice farmer can cultivate cannabis at home and at minimal cost.
This is where the inequality in access to cannabis begins; the right to grow your own cannabis is a bare minimum for meaningful cannabis legislation reform and yet in the UK only a handful of large corporations are able to acquire licenses to produce or work with cannabis. I and many other observers suspect that these licenses have been issued to businesses with personal connections to the conservative party, and there are already a number of MP’s who have declared connections in the pharmaceutical cannabis industry. To summarise; a small number of big players control the legal market for cannabis in the UK and it doesn’t look like that is going to change any time soon.
For patients, there are a handful of licensed private clinics where specialists are able to prescribe cannabis products. The cost of the consultations vary from £40 to £100, and prescriptions range from £50 a month to several hundred pounds for products that are produced in labs in countries like the Netherlands, Israel and Canada and imported to the UK through official channels. For some the expense is nominal; and indeed the prices have come down since the law was changed in 2018. What many people don’t realise is that prior to 2018’s reform, it was still possible to acquire legal medical cannabis if the individual could afford the license fees, as well as the ferry to and from the Netherlands where the drug could be purchased from a pharmacy under a private prescription.
You may remember that 2018’s reform of medical cannabis law was driven in part by the plight of a young boy called Billy Caldwell whose life-threatening epilepsy was exacerbated when customs officers confiscated his medical cannabis at the airport. Within 24 hours he was in hospital, and due to the immensity of the looming PR disaster the Home Office relented and tweaked the law to allow cannabis on prescription. The irony in all of this is that for many, in fact nearly all of the families of children with potentially lethal epilepsy, are unable to access medical cannabis on the NHS, nor are they able to obtain a legal prescription privately in the UK because there are no private clinics that specialise in paediatric cannabis medicine. These families still have to import and of course pay for plant derived medicines at enormous expense.
Part of the NHS’ reasoning for their cautious assessment of cannabis is financial; decision makers are not convinced that these admittedly costly cannabinoid preparations offer value for money. As the international evidence base grows, and as more and more individuals come forward to share their experience, the NHS appears out of step with the developments in understanding of the utility of medical cannabis. I know that when the law changed in 2018 there was widespread belief that cannabis would soon be available free at the point of need from GPs and hospitals across the country. Unfortunately this has not been the case.
There are an estimated 100k legal medical cannabis patients in the UK, and as they are accessing their medicine privately, there is limited data on the demographics. Nevertheless we can safely assume that these legal patients all have one characteristic in common; they can all afford their scripts.
I’ve heard patients complain about how much they pay for their cannabis medicine, and some who are delighted with the value they are getting, but ultimately there is a line between those who can afford legal weed, and those who cannot. The overwhelming majority of cannabis consumers in the UK do so without the oversight of any kind of medical professional. Many consumers grow their own cannabis and I would be curious to learn if there is any quantifiable difference in the kinds of outcomes these individuals experience. Does legal weed work better because it was more expensive or in spite of it? I suspect that the answer to that question lies at the end of a long and costly investigation that many researchers would like to conduct, but few funding bodies would pay for.
While we’re on the topic of research and funding, it is worth mentioning at this point that for over 50 years now, scientists have had many complex and costly hoops to jump through to be able to ask questions about cannabis. Notoriously, research licenses are issued by the home office directly, and at non-insignificant expense. Anyone who has ever tried to ask pertinent questions about the value of cannabis as a medicine, has also had to try and raise funds to pay for the license, and simultaneously negotiate with a governmental department hostile to the truth about weed. It should come as no surprise that for many years the only research done into cannabis in the Uk focused on harm, and almost all of these studies were conducted by one London university who roll out the reefer-madness rhetoric every year when its time to solicit donations.
Cannabis is a cheap drug, as much as we can joke about how expensive some varieties have become, the financial cost of growing cannabis pales in comparison to the process of getting a novel pharmaceutical agent to market, and yet here in the UK our laws are such that cannabis is only legal if you can afford to go private, and even then as many patients have discovered, it is still possible to have your cannabis confiscated by the police. Throughout modern history, cannabis is frequently associated with individuals of low socio-economic status, specifically because it is a cheap drug. Anecdotal evidence suggests that many police officers are ambivalent about cannabis generally, but it’s a convenient excuse to keep so-called “undesirables” locked up for possession.
The majority of harm associated with cannabis is experienced by people identified as coming from a low socio-economic strata. Statistics from Public Health Scotland show us that an individual’s level of economic deprivation is inversely correlated to the harm experienced from cannabinoids; with low earners more than 10 times more likely to be hospitalised than those from more affluent backgrounds. Of course, as mentioned earlier in the podcast this will be due to a number of interlocking and overlapping factors, but nonetheless it is important that we recognise that poverty contributes to the harms of cannabis prohibition.
I happen to believe that all forms of drug prohibition are counterproductive, inevitably concentrating power in the hands of criminal gangs. I also happen to believe that cannabis prohibition has a number of pernicious features, not least the fact that cannabis is actually what we could call a public health unicorn; not only can it treat diseases, but it can also prevent some disease altogether. Better yet, it does its work without harming the individual and for the most part it is fun to consume! It almost seems too good to be true that such a valuable medicine is also one of the cheapest, but perhaps it is.
In the UK, inequality has been a topic of growing concern, especially after the last 12 years of conservative government. Incomes have decreased in real terms, and we even before Covid and the war in Ukraine, the British economy was characterised by low productivity and wage stagnation. The division between the haves and have-nots has never been clearer, as cabinet of millionaires make policy decisions with very real consequences for the people of the country. Cannabis is already a multi-billion pound industry in the UK, largely controlled by the illicit market. A handful of private clinics are able to prescribe medical cannabis to those who can afford it, with the central irony being that the people most likely to need medical cannabis are those who cannot afford the luxury of private medical care. Law enforcement is still called out to investigate people growing weed in their attic, while multi-billion pound corporations donate to or even employ MPs who are able to represent the interests of people who do not need, and likely do not even use cannabis. Meanwhile, people who live on dwindling incomes in struggling communities where services have been cut to the bone are more likely to experience the harms from cannabis and need to take the risk of interacting with the black market if they want to access what for many is an essential medicine.
For what its worth, I think the only way to limit the impact of inequality on access cannabis medicine is to legalise and indeed, liberate the cannabis plant. It needn’t cost the earth to access something that grows from it.
I think that GPs should be able to prescribe cannabis, and I also think that you should be able to grow your own. I even think that businesses and communities should be able to buy, sell, grow and consume the plant and that researchers shouldn’t have to fork over thousands of pounds to prove what we already know; cannabis is only dangerous because its illegal.
Thank you very much for listening, and until next time take care.