A Response to NICE Guidelines, from Israel

Since the early 1990s, Israel has stood at the front line of cannabis medicalization. The acceptance of medical cannabis by clinicians, researchers and government bodies is fairly universal, and patients have benefited from widespread access to full-spectrum cannabis in flower and oil form. The supportive regulatory environment has facilitated a mounting body of clinical and transnational research demonstrating the efficacy of medically prescribed marijuana. Israel’s approach to cannabis has contributed to reducing stigma and increasing access for patients around the world.

Recently the Israel Medical Cannabis Agency (IMCA) implemented sweeping reforms aimed at achieving greater consistency and expanding patient access. The transition period has been painful, with huge gaps in care and tens of thousands of patients struggling to obtain, fill, or renew their prescriptions. The suffering of these patients is heartwrenching. Their plight has elicited public outrage and galvanized multipartisan support for medical marijuana in Israel’s upcoming election.

“Despite its legality, virtually no NHS prescriptions for CBMPs have been issued”

This consensus is not unique to Israel – many countries weighing legalizing medical cannabis are doing so under public pressure. England is one such country. The pleas of parents fighting to treat their sick children are impossible to ignore, as evidenced by the impact of Billy Caldwell and Alfie Dingley’s parents in shifting the UK’s regulatory framework for medical cannabis. Cannabis-based medicinal products (CBMP) were legalized in November 2018, and yet, this step forward has been followed by foot-dragging to the disappointment of many.

Despite its legality, virtually no NHS prescriptions for CBMPs have been issued. Currently, only specialist physicians may prescribe cannabis and are held accountable to justify not pursuing standard options. This has discouraged many doctors from offering cannabis even in the face of obvious benefit and despite the requests of patients who have found relief from the plant. This bottleneck has left patients and parents to pursue unregulated avenues to access treatment.

For months, medical professionals and patients have been waiting for the National Institute for Health and Care Excellence (NICE) to issue guidelines for prescribing cannabis-based medicine. NICE develop evidence-based guidelines on a wide range of health-related topics, including integrating novel and emerging therapies. Ahead of legalising medical cannabis last year, the NHS commissioned NICE to develop prescribing guidelines and cost-benefit analysis for physicians and patients. These have been highly anticipated, with many doctors stating they are waiting on the guidelines before agreeing to prescribe cannabis.

Last week NICE released the first draft of their evidence-based guidelines, concluding it could not recommend CBMPs for routine use because of high cost and a dearth of clinical trial evidence. Paul Chrisp at NICE explained in the draft guidelines: “We recognise that some people will be disappointed that we have not been able to recommend the wider use of cannabis-based medicinal products. However, we were concerned when we began developing this guidance that a robust evidence base for these mostly unlicensed products was probably lacking.” NICE recommendations do include fast-tracking clinical trials, however, this will take time, and time is something that patients treated with cannabis cannot afford.

“Prohibition and its effects are being used to perpetuate limited access”

This statement from NICE is hugely disappointing and has the potential to further restrict patient access to medical cannabis. The group’s misguided conclusions are a strawman: prohibition of cannabis and the requirements of Helsinki have severely limited research into the plant’s potential medical applications, ergo less gold-standard randomized controlled clinical trial data. Pharmaceutical companies often fund and initiate randomised clinical trials to validate their drugs, however, in the case of cannabis these interests were absent and this constitutes an additional reason for the limited clinical trial data on cannabis. Prohibition and its effects are being used to perpetuate limited access to a safe, efficient and virtually side-effect free treatment – this is fundamentally unethical and constitutes harm to patients.

Furthermore, as Alfie’s mother, Hannah Deacon, has explained and Israel can attest to: “There are hundreds of thousands of people using cannabis-based medicines across the world and it’s having an enormously positive impact on their health.” Despite recent challenges, Israel has supported medical cannabis for decades, and this scheme has generated large quantities of data. While prioritizing clinical trials is an important step, denying the efficacy of cannabis is irresponsible and short-sighted. We have seen first-hand how cannabis saves lives and improves quality of life – it is tragic that England is denying this treatment to its most vulnerable citizens.

The initial adoption of medical cannabis in Israel progressed to normalisation that includes government-funded research, data collection, and heavily subsidised product. The Ministry of Health has signed off on prescribing for a wide range of indications including intractable epilepsy, PTSD, chemotherapy-related symptoms, multiple sclerosis, and many more disorders that NICE ignores in its guidelines. Israel’s 40,000 patients treated with medical cannabis have benefitted from this access, and their experiences contribute to a mounting body of evidence attesting to the plant’s demonstrated efficacy.

iCAN statement

Israel-Cannabis has been involved in the global movement to increase access to medical cannabis for five years, and throughout this time we have heard from hundreds of patients around the world who have been helped by it. We strongly encourage physician associations and legislative bodies in the UK to examine Israel’s research and evidence attesting to the benefits of medical cannabis. NICE’s guidelines are harmful and unjustifiable – these should not serve as a framework for medical cannabis prescription.

About the author

Corinne Norton-Berzon is a passionate cannabis writer and researcher at iCAN: Israel-Cannabis. She received her PhD in Medical Ethics from Bar Ilan University and applies her unique skillset to advocating for and reporting on cannabis. Corinne is a dedicated bibliophile, an earnest supporter of access to medical cannabis, a pedantic and exacting editor, and, most of all, a mom to four kick-ass daughters. Corinne can be reached at corinne@israel-cannabis.com

About iCan

iCAN: Israel-Cannabis is building the global cannabis ecosystem by identifying and accelerating innovative medical cannabis technologies. iCAN uses its global network to position Israel as the world’s leading medical cannabis tech hub while creating synergies and cooperation across the industry. As part of its mission, iCAN created CannaTech, a leading-edge B2B cannabis convention that showcases emerging markets, technologies, and investment opportunities.

Further investigation and research into cannabis use (both recreational and medical) is thoroughly encouraged by The Academy, particularly through the use of our own online coursesevidence base and whitepapers.

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