After all the delays, obfuscations and denials, the British are finally taking the next obvious step toward a better understanding of the medical efficacy of cannabinoids. Namely, a highly limited medical cannabis trial dubbed Canpain focusing on chronic pain has just been announced. However, so far, despite reports to the contrary in the media, including The London Times, medical regulators have still not formally authorized a wide-spread study of cannabis and pain management.

While a small trial is a good first step, the question remains why this has taken so long to even get going, let alone why the project is so limited.

Canpain is not the first cannabis experiment in the country and is far from the largest. That distinction goes to Project TWENTY21, organized by a non-profit research organization called Drug Science. 

However, Canpain would be, upon proper launch, the first government backed trial which could also lead to patients finally being prescribed medical cannabis via the National Health Service (or NHS).

Its success remains in doubt, however, particularly given what is happening elsewhere in Europe right now. This includes Germany, the largest reimbursed medical cannabis market in the EU, where public health insurers are increasingly turning down applications for medical cannabis authorization on the basis of “just” chronic pain.

What Is Actually About to Happen

The initial “feasibility study” will be conducted by a private cannabis clinic, LVL Health, which will first enroll 100 patients as a first step of the larger experiment (which has not yet even been approved by the NHS). Canpain aims to enroll up to 5,000 adult patients who will receive cartridges with unprocessed cannabis flower on a daily basis for at least one year. 

This will not be completely free. Patients will have to pay about $300 per month to receive capsules embedded into vaping devices. 

What Is New?

The big news here is that NICE — the National Institute for Health and Care Excellence — will, once the feasibility study is reviewed, approved, and launched, examine the data to determine if the clinical evidence justifies the prescription of cannabis for chronic pain. 

In the past, NICE has specifically denied that there was any evidence supporting the use of cannabis to manage chronic pain. According to government data, one in three Britons suffers from this condition—defined as that which creates severe discomfort for more than three months.

By definition, the new Canpain trial in the offing is also admitting that their first limited medical efforts will also exclude most of the chronic pain patients in the country.

In the US, in sharp contrast, the number one reason for medical cannabis use is in fact, chronic pain.

The Slow, Shameful Pace of Cannabis Reform In the UK

Like everywhere else, cannabis reform of even the medical kind has been vigorously fought by British government authorities and agencies, even after medicinal cannabis was technically legalized here in 2018 and a larger medical trial, albeit still limited, was launched in Germany in 2017. Even fewer people have actually gotten prescriptions in the UK than Germany since then via the NHS. Even worse, thanks to the NICE intervention, chronic pain patients were explicitly excluded from receiving reimbursed care post 2018, even if they had managed to obtain such permission previously. Only 18 cannabis prescriptions were subsequently written through the NHS (for whatever reason) and only 259 private prescriptions were issued in 2019.

ProjectTWENTY21 launched in August 2020 with the goal of providing lower cost cannabis to registered patients and studying the same with the goal of providing a large-scale clinical trial that also helped patients obtain cannabis at a lower cost than is available through private medical care. Many cannabis cultivators signed up, at a considerable cost, to be able to provide lower cost cannabis via this trial. About 20,000 patients have subsequently become part of this trial which has now expanded to Australia.

It is not clear why this data has so far been ignored by government authorities.

In the meantime, both further medical and recreational reform debates continue to rage in the UK as the mayor of London, Sadiq Khan, has announced that he will launch a recreational cannabis decriminalization trial in certain parts of London.

Beyond this effort, no British national authority has taken either medical or recreational cannabis reform seriously.

As a result, British, just like other European patients are still mostly left out in the cold and stuck between outrageous monthly costs via private health care, the black market, or going untreated (which is obviously not a viable option for most patients).

The Criminalization of Legitimate Patients Continues

For all the police press releases about tackling drug crime, there is no effort currently underway to track the fates of legitimate patients who are routinely arrested and prosecuted under federal narcotics laws which they are still subject to when their applications for medical treatment are denied (for whatever reason). All of these patients must go somewhere to find another source to obtain cannabis and, when turned down by insurers, this almost always means that such individuals have to turn to illicit sources because they cannot afford private care. 

In Germany right now, insurers are routinely turning down 40% of patient applications — and for a variety of specious reasons including supposed lack of clinical evidence — even when presented with the most recent data, refusing to process complicated forms that even doctors get “wrong” or even denying patients reimbursed care because their healthcare provider sent in forms later than insurance company imposed deadlines. The only reliable way to obtain legitimate medical cannabis in Germany right now is to have enough money to obtain private healthcare or sue one’s public insurer.

Despite all the protests, and data, one thing is clear. There is a long, hard fight still ahead before the cannabis plant is normalized, anywhere.

How many more people have to face criminal charges or even die before that happens?

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