By Emily Ledger
Cannabis has been prohibited in the UK for almost a century, but prior to this, its use was widespread in the medical world. The plant enjoyed a long period of medical acclaim in the Western world after being used in parts of Africa and Asia for thousands of years. Since prohibition, however, medical research experienced a crippling decline that is still affecting our understanding of the plant today.
Medical History in the UK
Despite medical use of the cannabis plant dating back to ancient times, its export to western Europe and the UK came reasonably late. In 1833, Irish clinician William O’Shaughnessy began experimenting with the plant after noticing locals that locals in India were using it for the treatment of a variety of ailments.
This research led to O’Shaughnessy became increasingly interested in the medicinal potential of the plant and wrote extensively on the subject. Eventually, he recorded that cannabis oil had been used successfully to treat the constant seizures of a young baby.
From this time, doctors and pharmaceutical companies in the UK touted the plant as a treatment for a variety of conditions, including joint pain, cholera, and seizures. Famously, cannabis was also used to treat Queen Victoria’s menstrual pains.
Despite the widespread use of the plant, this era was not to last. As lawmakers and the ruling elite became increasingly concerned about the changing society, cannabis prohibition. Early prohibition mechanisms in the USA were steeped in racism, stirring up a moral panic among the population and targeting minorities.
This prohibition only made its way into Britain itself, after colonialists had begun to impose bans in the colonial territories, such as Mauritius, India, and Jamaica. Reports from the time blame the plant for “demoralising and deplorable [behaviour among] the natives”.
The prohibition of cannabis, introduced at an international level in 1928 by the League of Nations, fuelled a stigma around the plant that has remained ever since. This stigma, alongside the new barriers restricting access to the plant, served to significantly halt medical cannabis research.
Despite this setback, however, medical Cannabis continued to be available through the NHS until the early 70s. The final banning of Cannabis came with the Misuse of Drug Act 1971. Cannabis was placed in the most restrictive schedule (schedule 1), restricting even medical use and research.
Despite cannabis being used medicinally for thousands of years, prohibition came at a time when medical research methods were developing at a pace never before seen. This has resulted in a severe gap in knowledge around the medical effects of the plant and its compounds.
In the UK, medical cannabis was only legalised in 2018, via it’s rescheduling within the Misuse of Drugs Act 1971. Prior to this change, cannabis was considered among the most harmful substances available. It was placed in the same category as heroin and was considered to have no medicinal or therapeutic benefits.
Since the rescheduling, few people in the UK have been provided with a prescription for medical cannabis products. Clinicians and policymakers throughout the UK and the rest of the world quote a lack of evidence for their hesitation in prescribing the medication.
A Lack of Evidence
In order for a new medication to be licensed in the UK, it must be shown to be at least as effective as alternative medications that are already available. Alternatively, it must have fewer or less harmful side effects.
The clinical and licensing communities also overwhelmingly expect these benefits to be demonstrated through double-blind, controlled clinical trials. And yet another hoop to jump through, policymakers also have an inconvenient preference for homegrown British evidence.
Gaining approval for cannabis research during prohibition, and even after the rescheduling, was also excessively difficult. Taking all of these factors into consideration, the well-quoted ‘lack of evidence’ is hardly surprising.
Despite ongoing barriers to medical cannabis access and research, the UK remains one of the biggest exporters of medical cannabis products in the world.
Nevertheless, the long and disappointing prohibition and its ongoing effect on cannabis research, the future may be brighter. In 2019, Drug Science announced in 2019 that they would be launching the largest medical cannabis patient registry in Europe. The registry, Project Twenty 2021 is now live in the UK with an aim to recruit up to 20,000 patients by the end of 2021.
It is hoped that this research will significantly add to the evidence needed for the recommendation of medical cannabis treatments.
As an increasing number of jurisdictions – including large and influential countries – continue to legalise both medical and recreational Cannabis, access and regulation of the plant are expected to improve. As this happens, Cannabis research may also see an increase in both quantity and quality.