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The Nation: Professor Michael Barnes

On Newshub Nation: Lloyd Burr interviews professor Michael Barnes

Countries around the world are also dealing with medicinal cannabis. Britain legalised it last year, but the uptake has been slow. Neurologist Professor Mike Barnes wrote the report that convinced UK lawmakers it was a good idea. He's coming here soon to get GP's ready for the green rush - so Europe Correspondent Lloyd Burr asked him about who - in the UK - is having it prescribed.

Michael Barnes: Well, actually, the surprising answer is very few people are taking it at all. It’s available legally through a doctor’s prescription, but there’s not one single patient on the National Health Service – the public provision – who’s been prescribed medical cannabis since the law changed on the 1st of November. There’s been about 22, I think the answer is now, private prescriptions written, which is unfortunately very expensive because of the supply chain problem. So, we’re very slow in picking up this opportunity.

Lloyd Burr: So, is it a supply chain issue, or is it just the fact that there’s not a demand – people don’t want to take it?

I think there’s a huge demand. In the UK, our best estimate is about a million people take cannabis for medical purposes every day, and if you add to that those who aren’t taking it because they don’t want to break the law, you’ll probably get one-and-a-half to two million people who would benefit from medical cannabis. So, the big block is the doctors being unwilling to prescribe. We have a very conservative medical profession – that’s worldwide, but particularly in the UK – and they’ve just been very slow to take up this opportunity.

So, what has it done to the black market for cannabis in the UK?

Well, at the moment it probably has no dent at all in the black market, with 22 prescriptions. And at the moment, sadly, you can still obtain cannabis on the black market much, much cheaper than you can for a legal prescription. Now, of course, there’s problems with the black market in knowing what you’re getting, what contaminants it has in it. It’s nowhere near the same quality – of course it’s not. But, sadly, at the moment, because it’s so much cheaper, the black market is still flourishing.

So, why is there this discrepancy there between stuff that is regulated and produced and is actually safe to consume, and then you’ve got stuff that is illegal – it’s on the black market – and yet it’s so much cheaper?

It is a crazy situation. The demand is definitely there, and what we need to do more than anything else is to educate our doctors. At the moment, of course, doctors haven’t been trained in cannabis medicine – they don’t know what to give, they don’t know what dose to give, they don’t know what format to give it in – and no one wants their doctor to prescribe something they don’t really know what they’re doing. So, the priority by far is to educate our doctors, and get rid of the stigma of cannabis, because it’s been an illegal product. It’s had that thought in people’s minds that it’s associated with anti-establishment views, hippies – all those images we have of cannabis over the last 50 or 60 years. We’ve got to break down that stigma that’s associated with it and tell our doctors a) that it’s really safe and b) that it does actually help a huge number of people with chronic conditions.

So what you’re saying is it’s going to take a long time, I guess, to bed in, not just in medical training and GPs and things like that, but in society as a whole.

Yeah, I think society as a whole is actually very accepting of this. There’s a couple of surveys recently that showed over 80 per cent of the population were in favour of medical cannabis, and indeed – strangely – 80 per cent of doctors in the UK are in favour of medical cannabis. It’s this gulf—gap between what they know, what they want to do and what they can do because they feel empowered to do it, and that—we’ve got to break down that empowerment gap, if you like – that knowledge gap. That’s the key to it.

So, as you’re aware, we’re going through the same process in New Zealand of making medicinal cannabis legal. Are you concerned that we’re going to repeat some of the same mistakes that the UK made?

Sadly, where cannabis has been introduced medically in every jurisdiction, it’s taken two, three, four years for the medical profession to catch up with the legal changes. That happened in Canada; it happened in Germany; it’s happened in the United States, where it’s legal now. So, I hope that each jurisdiction that comes on the stream, that gap between the law changing and the medical opinion changing will be less and less. So, I hope it will be quicker in New Zealand. I think we’re still coming back to the same point – it’s got to be the education of the doctors, the reassurance of the doctors and the knowledge of the doctors that will break down those barriers and get them prescribing more quickly.

One of the proposals that’s in New Zealand is that medicinal cannabis is going to need the sign-off of specialists. What is your opinion on having specialist sign-off on medicinal cannabis?

Well, we have the same issue in the UK. It can only be signed off by a doctor on what’s called the Specialist Register – so basically a hospital consultant. I think that’s an error. I think the UK government got a lot right when we changed the cannabis laws – they’re quite liberal in this country; we can prescribe any type of cannabis for any condition – but I think the one mistake they made was not allowing general practitioners to prescribe. After all, very few doctors know anything about cannabis, so why restrict it to specialists who know nothing about cannabis, as opposed to GPs who know nothing about cannabis? Why not get the whole of the medical community up to speed? And cannabis is a symptom-controller. If you take cancer, it can help anxiety; it can help pain; it can help muscle spasm; it can help appetite. There’s a load of things it helps with cancer, for example, and GPs are very well-placed to prescribe, if you like, for the whole patient. So I think it should be allowed to be prescribed by any medical practitioner with the right knowledge.

It sounds like, despite the law change, it’s still impossible to get your hands on it. Even if you go to your GP, your GP will have to refer to someone else. It sounds like that’s just—it’s an impossible, kind of, system they’ve implemented here.

It is. It is a very difficult system. So, you can get it privately. There’s 22 people who have been prescribed it. But the expense of that—First of all, it’s sad, because, of course, the expense has excluded most of the population. 95 per cent, plus of the population can’t afford it. Because there’s so few prescriptions being written, it’s very expensive. You have to import it – there’s only import cannabis in this country – and you have to do one patient at a time for one month’s supply, and if you add up the time that takes and the import license fees and everything else, you’re looking at something like £800-900 sterling per month per patient, and most people can’t afford that. So we’ve got a lot wrong in this country, and I hope education comes first in New Zealand, and I hope it opens up to all the doctors who want to get trained.

So, I guess, then, what is your message, not only to the New Zealand government and those making the laws, but to Kiwi GPs?

I think embrace it. It’s not a cure-all for everything. It’s not a wonder drug. It is another very good and very safe—That’s the point to emphasise – it’s very safe. There are very few risks to cannabis. It does benefit a lot of conditions that are troubling to a lot of people, like pain; like children with epilepsy, for example; like anxiety, post-traumatic stress disorder, Crohn’s disease. There’s a lot of things for which there is a reasonably good evidence base. Now, we do need more research and we need more evidence, but in my view, there’s enough evidence base for people to understand this and prescribe this and help a lot of people in New Zealand.

Has it been over regulated here in terms of red tape?

It has to some extent. I think the red tape will fall away once the medical profession are prescribing, because then we’ll have volume prescription, the supply chain will be improved, and those bureaucratic hurdles at the moment will slowly disappear.

You’re going to New Zealand soon. You’re being brought over to New Zealand by a company that makes medicinal cannabis. Can you tell us a bit about that trip?

That’s organised by Helius Therapeutics. I’m going next week, and I’m going to do a one-day, what they call master class in Auckland, followed by Wellington, followed by Christchurch, and that’s open to any doctor. And I also think the New Zealand regulators are going to come on each day and tell the medical community assembled there what the regulations are likely to be, although I gather it’s still out for consultation. So, that’s very helpful, and it’s good to see the regulators being involved in that sort of training. And that’s what we got wrong in the UK is the law changed – and changed very well and very quickly – but they left the medical profession behind. So it’ll be nice to see in New Zealand that the medical profession is brought along with the same pace as the law change.

Transcript provided by Able. www.able.co.nz

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