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'Use of medicinal cannabis should be based on scientific evidence, balance of risk, expert judgement and overall cost to the NHS' says Dr James Gill

Dr James Gill, GP and Honorary Clinical Teaching Fellow at Warwick Medical School discusses the potential use of of medicinal cannibis.

'I personally have administered opioids to patients - when dealing with patients in terrible pain, and those with crushing acute heart failure. We call it diamorphine in the medical world, and no one bats and eye. But you are certainly not going to be able to pick it up from the pharmacist or use it at home.

Conversely paracetamol is available over the counter, on a daily basis I advise patients on taking the maximum dose - two 500mg tabs, four times a day. But if you take ten tabs a day for a few months, it will kill you. Yet you can buy paracetamol at most petrol stations. The conceit here is that if paracetamol was brought out by a drug company today, it might not be released, and certainly would have much tighter controls to it.

Sticking purely to the medicine; when doctors graduate, we promise to do no harm. Now we do get that wrong occasionally - in the past doctors used to prescribe cigarettes, even for asthma. I’m pretty sure that in 99% of cases you are not going to find a doctor advising patients to take up smoking today.

There is a growing body of evidence to show that cannabis may have beneficial properties in certain groups. MS, and chronic pain conditions for example. But that doesn't mean that you should be able to buy cannabis cigarettes from the local cornershop. In the realm of pharmacology there is a myriad of medicines and drugs which have a balanced risk and are prescribed both in controlled settings, and with a careful decision making process on who should receiving those medications. A decision made by balancing risk of harm to the patient vs the benefit they may gain from it.

Subject cannabis to the same processes any other medical drug has to go through. Let researchers prove a medical benefit, allow ethics committees to determine the ethics of formal drug trials, then let the research be submitted for marketing, and restriction like any other drug based on those findings. We already have controlled drugs. We already have very stringent guidelines on what medications are allowed to be prescribed, by whom, to whom and for what reasons.

Those guidelines are based on scientific evidence, balance of risk, expert judgement and overall cost to the NHS. I return my original point, heroin is a vital drug, it is proven scientifically to be a valid and crucial medication used in a series of medical complaints. But that doesn't mean that heroin should be available over the counter. We need to ensure that the balance of risk is reasonable for a drug and it’s delivery system. I find it very doubtful you’ll find a single chest physician in the country who is going to state that growing a plant, burning it and inhaling the smoke is the safest, let alone the most effective delivery route.

If it wasn't for the politics, opinion and the current legal status surrounding cannabis, we probably wouldn't be having this argument now. Allow cannabis to be trialled, and tested as with any other medication. If the evidence supports a therapeutic benefit, allow it to be used. Do it properly, do it slowly, take politics out of it, and let the science, not opinion and emotion guide the answer.'


Alex Buxton

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