Pubdate: Tue, 12 Nov 2019
Source: New York Times (NY)
Copyright: 2019 The New York Times Company
Author: Iliana Magra


LONDON - Cannabis-based medicines were approved on Monday for use by
the National Health Service in England and Wales, a milestone decision 
that could change the lives of thousands of patients.

Three treatments using medicinal cannabis were authorized by the
National Institute for Health and Care Excellence, a public body that 
provides guidance on health care practices. The decision comes a year 
after Sajid Javid, then the British home secretary, said that some doctors 
could legally prescribe the drug in special cases.

Cannabis-based medicine will be restricted to treatments for one of
two relatively rare forms of childhood epilepsy, multiple sclerosis,
or chemotherapy-induced vomiting and nausea, according to the
guidelines published by the institute.

All marijuana-based medicines must initially be prescribed by
specialist doctors, the institute said in a statement. A spokesman
said in an email on Monday that the recommendations could immediately be 
applied for England and Wales, with Northern Ireland expected to consider 
use on a case-by-case basis. The rules do not apply in Scotland, which has 
its own health care guidance body.

Simon Wigglesworth, the deputy chief executive of Epilepsy Action, a
British charity, said in a statement on Monday that he welcomed the
institute's decision to allow the use of cannabis-based medicines for the 
treatment of patients with Dravet syndrome and Lennox-Gastaut syndrome, 
both rare forms of epilepsy.

"Today's announcements represent an important step forward for people 
affected by severe and treatment-resistant epilepsies," he said.

Laws on cannabis are generally stricter in Britain than in the rest of 
Europe. Several countries have decriminalized small amounts of
marijuana for recreational use, and others allow medicinal cannabis.

The change in the guidance in England and Wales comes after two highly 
publicized cases of young epileptic patients in Britain who were dependent 
on the treatments.

In June 2018, the cannabis-based medicine of one of those young
patients with life-threatening seizures, Billy Caldwell, then 12, was 
confiscated at Heathrow Airport. Earlier, the mother of Alfie Dingley, 
then 6, said that the government had vowed to help explore alternative 
treatments for her son, who has as many as 150 seizures a month, but that 
the promise had not been fulfilled.

Both boys were issued temporary special licenses for cannabis-based
medicines, and their cases added pressure on the government to
commission a review of such products.

About 63,400 people age 18 and younger suffer from epilepsy in
Britain, Louise Cousins, a spokeswoman for Epilepsy Action, said in an 
email. She added that 5,000 adults and children in England are
estimated to have Lennox-Gastaut syndrome and about 3,000 had Dravet

More than 30,000 people are thought to have Lennox-Gastaut in the
United States, according to the LGS Foundation, a nonprofit
organization focused on raising awareness about the condition.

The National Institute for Health and Care Excellence also recommended the 
offering of a four-week trial of a cannabis-based oral spray for the 
treatment of muscle spasms caused by multiple sclerosis, if other 
treatments have had no effect. The spray was already available in Wales.

Genevieve Edwards, the director of external affairs at the Multiple
Sclerosis Society, a British charity, said that the group had been
campaigning for access to the spray "for years," but she criticized
the institute's guidelines as not going far enough.

"No cannabis-based treatments have been recommended to treat pain, a
common symptom" of multiple sclerosis, Ms. Edwards said in a statement on 
Monday. The charity said in an email that more than 100,000 people in 
Britain live with multiple sclerosis.

Local commissioners and health care providers are expected to apply
the advice "in the context of local and national priorities for
funding and developing services," according to the institute's guidance.

Paul Griffin, 49, who is from Bradford, in northern England, has had
multiple sclerosis for 23 years. He said that access to the spray,
called Sativex, and to the relief afforded from the constant pain
induced by spasms would be "life changing."

"It's been incredibly frustrating to know Sativex could help, yet it's 
been out of reach for so long," he said.

The institute also recommended the consideration of nabilone, a
manufactured cannabis-based product, as a supplementary treatment for 
patients who are at least 18 years old and have chemotherapy-induced 
vomiting and nausea that conventional drugs have failed to stop.

Charlotte Caldwell, the mother of Billy Caldwell, told Sky News on
Monday that she was delighted about the new regulations.

"This is how our N.H.S. should be," she said. "It is an incredible day for 
the U.K."
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