The legal situation with respect to SATIVEX continues to be a mess. SATIVEX is a cannabis medicine developed by GW Pharmaceuticals which has been approved as a prescription medicine for the treatment of plasticity caused by Multiple Sclerosis, its a subject this blog has covered back in October. Just to recap an important point: SATIVEX is cannabis, it is not a pure chemical extracted from the plant, it is all of the active ingredients obtained from the blending of two specific  strains of cannabis. There has been an extraction process which has removed all of the vegetable matter, but pharmacologically SAYIVEX is cannabis.

This is a very important point to make because if the flowering heads from a blend of the plants used to make SATIVEX were rolled into a  tobacco filled joint and smoked, the same cannabis chemicals would be inhaled (albeit along with all the other stuff in the smoke from the burned vegetation and of course the tobacco) as SATIVEX delivers in its spray, the point being the preparation and delivery method is irrelevant to the cannabis content of the drug. This is important because the Misuse of Drugs Act defines cannabis as a Schedule 1 drug, with no medicinal value. We therefore have the rather odd situation of the NHS prescribing a drug not recognised under law as having any medicinal value and this is often used as an excuse to withhold SATIVEX by Patient Care Trusts (PCT’s) . This has to change and the government is fully aware of it and has been for some time.

Professor Les Iversen wrote to James Brokenshire in the Home Office on January 17th with an outline of the situation. It is the recommendation that cannabis based medicines be moved to category 2 or 4 of the Misuse of Drugs act, which would recognise the medical applications. This has been its position since 2003, eight years ago! However, it isn’t as simple as some might have liked, which is why it hasn’t happened yet.

Professor Les Iversen reminds the minister that

The ACMD is also aware that it will not be appropriate to refer to “Sativex”, which is a proprietary name, in any amendment to the misuse of drugs regulations, and that a suitable description of the relevant component(s) of “Sativex” will have to be scheduled (with appropriate consequential amendments to the Misuse of Drugs (Designation) Order 2001).

And therein lies the problem, how to do this whilst not also including the raw cannabis the stuff is made from, which is what the government is insisting on?  Contrary to much evidence and indeed practice around the world the government continues to claim that herbal cannabis has no medicinal use, so rather than fully legitimise the SATIVEX product it has kept it schedule 1 in order to keep the full prohibition of cannabis intact. It’s a real case of an unstoppable force meeting an immovable object, the sort of thing that can’t happen in the real world but does with prohibition laws and politicians.

Professor Iverson tries to justify treating SATIVEX differently to raw cannabis because

The ACMD concludes that Sativex has a low abuse potential and low risk of diversion.

Which in English means it is unlikely in their opinion to find its way into the non-medical recreational trade, but is this really true?

A lot of the publicity surrounding SATIVEX suggests that it doesn’t work as an intoxicating drug; great play is often made of the fact the half of it is made from low THC/high CBD plants, rather less is said about the other half. In truth SATIVEX is near enough 50% THC, which means that half of each squirt contains THC, the major psychoactive ingredient of cannabis. In truth SATIVEX would probably be quite a pleasant form of recreational cannabis, the high CBD content reducing the unwanted psychotic effects of the THC dose quite nicely.

It isn’t the nature of the drug cocktail that prevents it being of interest to recreational users, in passing it’s worth noting that the ratio of 1:1 THC:CBD isn’t that far removed from the ratio that used to be found in traditional imported hash as the Home office potency study of 2008 claimed to find. Oldskool Moroccan Hash certainly did the trick and no doubt SATIVEX would also.

Indeed, if people such as Psychiatrist Dr Marta Di Forti, who’s worried about high THC “skunk” links to psychosis are to be believed, it would probably be preferable to see SATIVEX on the street market. As she reported to the cannabis and mental health conference in 2008

In contrast with skunk, hash contains much less THC and an almost equal amount of CBD, which might contribute to further reduce the potency of its adverse effect. For example, Savitex, the cannabis drug, used to treat multiple sclerosis, has equal amounts of both THC and CBD.

The fact that the hash oil (which is what SATIVEX actually is) comes thinned out with alcohol isn’t going to put anyone off and the way the spray system delivers precise doses would surely be a positive marketing feature for your local dealer. So the delivery system isn’t standing in the way of it being taken up by the street trade either.

In short, SATIVEX has all the potential in the world to become “diverted” and “abused”, if it were cheap enough. The lack of “abuse potential” has nothing to do with the nature of the product or the delivery method, the only reason it hasn’t turned up on the black market yet is because it’s so expensive. SATIVEX is hugely expensive for what it is, if it weren’t for prohibition the same product could be supplied for a fraction of the cost. GW Pahrms are onto a winner with hugely inflated profits, lucky them.

Professor Iverson notes in his letter

It would be the first cannabis-based medicine to receive approval in the UK and it is likely to be followed by similar products from the same or other companies. The licensing of Sativex in the UK may be followed by licensing in other areas of the European Union.

In other words the present impasse over the scheduling of cannabis based medicine is standing in the way of the development of these medicines.

As a footnote there is some debate again within the cannabis law reform movement as to whether there should be specific campaigns for medicinal cannabis, indeed Facebook is saturated with medical cannabis groups. It is perhaps one of the more repellent features of cannabis prohibition that people who experience very real relief from pain and other medical benefits are prevented from using their medicine by a law which exists simply to stop people using the plant for purely pleasurable reasons. There are many people in the UK in great pain who have to source their cannabis from the uncontrolled illegal trade, people who the government refuses to accept should be treated any differently to recreational users.

It is true the the case for medical cannabis is strong and needs to be promoted effectively. However, it is also true that if the government accepted the reality of the widespread recreational use and decided to properly control the trade and to regulate the recreational supply, medical users would also be able to get their supply. The medical impasse and resulting suffering exists simply because of the prohibition regime applied to recreational use.