Sativex – still a forbidden medicine

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.

23 thoughts on “Sativex – still a forbidden medicine

  1. I think the government will pull some bullshit out of the hat to justify keeping approved medicines in a category designed for no medical use substances.

    Although I actually think they’ll just lean on the ACMD until they change their mind and just say Sativex is different to cannabis, when it is fundamentally the exact same thing, just in a tincture.

    The intellectual contortion required of politicians defending prohibition is quite impressive, and also sickening.

  2. Sam… I assume you have seen some of the new appointees to the ACMD? – a religious zealot and a crazy… I doubt they’ll have to lean very hard.

    In addition, the UK showed its colours with the last minute objection to Evo Morales Coca leaf exemption request. All of this just confirms what I have been saying about our government(s).. they are a bunch of sheep.. even with ‘liberals’ in it. When it comes to drug policy, our ‘leaders’ are weak and feckless. Change will come from elsewhere (USA or Latin America), and it will be forced upon us, and I for one, cant wait!

  3. I have indeed seen some of the new appointees, someone whose expertise is in ear acupuncture, and a rabidly anti-homosexual staunch prohibitionist. I don’t think we can expect evidence based policy when Raabe has openly admitted that he believes in a ‘just say no’ approach, no matter what.

    Change will certainly come from outside this country, I’m sure of that. For the next 4 years we’ve got no chance at least, and I think we’ll have another 5 years of Tories after that as well. I think the UK’s best hope is to look to the USA where the pack of lies is unravelling very quickly. Thank God for our American cousins who are willing to change their minds!

  4. I think that’s only because they value this thing called ‘freedom’ a lil more than us unfortunately.

    I have oft said that sometimes things need to get worse before they get better.. well, it appears we are heading into the ‘worse’ stage. All I hope is that actual academics/scientists such as Les Iverson have the strength to remain in position in the face of this clear anti-science policy making agenda…

  5. Anti Science Folk’s?. We Seem at Moments to be in the Flintstone’s Back Seat. Being Driven Back to the Stones Age. Some how converted with a Flux Capasator!. Worse?. So Funny, if it was’nt So Serious. Sad to Think that Logic never enters Reality at any POint at all in relation to Cannabis. Doesnt it? Some 30 odd Years. All the Trees We Could have Saved. No need for petrol Car’s. Hemp Clothing. Hemp Paper. Clean Soil. Unpoluted Rivers. No need for half the chemical’s we Pump into Mother Earth. Big Business Knows it. We The farms know it. The Sick are Slowing Getting to Know it Again. Hell They Know it. No Sorry. No Sativex. Really?. Why?. Sativex Really Makes me Laugh these day’s. Holed up here In Propaganda Land. Professor Nutt had to get the Boot!. They knew this time Was coming My Friends. The Cat’s Ass is So Much out off the Bag these days id say they have Trouble at Night Sleeping. Pardon the Rant Bit of Cannabis Passion to Release. Bike Crash Bad Hip in Bad Weather we;ve all got our Medicinal reasons, in Fact Its Your RIGHT!!!!.
    ITs a Persons Right, Sadly isnt it?. Medicate On My Friends. Sorry Derek. In No way are my Opions Endorced my the Web Site, Much Respect. D

  6. That’s quite hard to understand Declan. Capitalising every word makes it even harder!

    @Jake
    I’ve heard the ‘it has to get worse before it gets better’ thing before, and whilst I can see why people would think issues need to be forced by economic conditions, extremism showing the absurdity of a position etc, in my lifetime all I seem to have seen it things getting worse. Certainly in the time I’ve been closely following the situation it’s gotten a lot worse.

    The only glimmer of hope is that America legalises, because we ALL know that those states that do will not collapse. The trains will run on time, people will go to work, the world will not come to an end. Just some people will get stoned if they want to.

  7. Sam, I don’t think things have only been getting worse, by no means are they ‘good’ in any sense of the word but look at what we have currently: Some US states with (quasi)legal medical cannabis, Portugal, greater drives towards harm reduction, bigger political voices starting to speak out against prohibition i.e. Vicente Fox and even the possibility of a dent being made in the single convention with Evo Morales. This is a global issue, so setbacks here should be placed in context with what others are doing elsewhere.

    What I meant in terms of getting worse was that at least there was the façade of science in policy-making for ‘drugs’. Now, the new establishment have just blown that apart, headed by mr.brokenshire who thinks that “the criminal law can be an important way of directing patterns of behaviour” for non-violent, non-victim ‘behaviours’ (http://www.publications.parliament.uk/pa/cm201011/cmpublic/policereform/110120/am/110120s01.htm#11012052000163).

    The UK is a sheep globally, one that now seems to pander to sensationalism and yellow journalism more than science, evidence and fact. So don’t be too disheartened that we are taking a step back as others are taking two forward…

  8. I can’t believe we are still paying lip service to those who think cannabis causes Schizophrenia – the statistical evidence does bear this out ! There is some weak statistical evidence for tobacco, alcohol and caffeine but not cannabis. I also fail to understand the logic behind the principal “less psychoactive is better”. The psychoactive properties of cannabis help with many conditions not just those of the mind (such as depression) – they know this at the Californian Medical dispensaries and there is an ever growing body of knowledge that records how the precise mixture of compounds in cannabis helps various conditions. The whole discussion in the UK seems to take place in blissful ignorance of this knowledge and research – and it is not just anecdotal either. Many of these dispensaries are extremely scientific in analysing and recording the medicine they dispense and the benefits that the patients receive in order that they can give better advice and therefore compete with the other dispensaries. They operate in a crowded market place (in some towns patients have dozens of dispensaries to choose from) so they are not simply in the business of selling cannabis – they need to make sure it suits the patient and actually does what they want it to or people will simply go elsewhere.

    So long as the consumer knows what they are getting they can proceed with caution but as with anything else there will always be some who over-estimate their capabilities. But this approach of informing the user what they are buying is far less risky than the hit and miss situation we have with illegal supply. Some people will consume a whole packet of ibuprofen, bottle of vodka etc in one go but most do not- why can these same people not be allowed to exercise restraint and good judgment with other drugs (recreational or otherwise) ? All we need to do is tell the truth about what each substance does to people and the truth really is out there !!

  9. Sorry Sam, Impassioned Rant above, i did’nt mean to Rant so much but the lies make my old blood boil. Sativex and how it bean surpressed dont surprize me, of course. Its just A Brick wall of Political Proaganda that Sickens me.

    Peace Declan

  10. 1. Agree with Jake, we are making progress. Please everyone, join in reviewing and improving Wikipedia articles (most massive readership anywhere on cannabis issues) and
    moderate dosage– no hot burning joints–
    equipment mfg. guides on wikiHow.com.

    Psychoactivity deserves the advocacy it is getting from phrtao and others. In all the debate about “medicinal” vs. “recreational”
    benefits of cannabis, many
    forget “inspirational”– or if that’s too vague, how about “occupational”? If you’re Paul McCartney, “Gotta get you into my life” means cannabis– without it Blackbirds wouldn’t fly. Japanese airport bureaucrats arrested McCartney and confiscated 7 grams, I think, or was it ounces? Shot themselves in the foot, they did. Whence cometh the inspiration for that art thousands of ticket buyers– all good Japanese citizens– paid so much to hear?

    (Q. Did you hear what happened to McCartney when he was 64? A. Some woman sued him for 400 million dollars!)

  11. Macca got caught with half a pound in 1980 which he claimed was 2 weeks personal supply whilst he toured japan. He also claimed that when marijuana plants were found growing on his remote scottish farm that – some one had sent them some seeds and some had come up illegal after planting !?
    (This page tells the whole shocking history of the McCartneys’ drug abuse-
    http://www.10zenmonkeys.com/2007/01/03/paul-mccartney-on-drugs/)

    It is not the strength of his excuses but his vast fortune and fame that protects him from the consequences of a few ‘mistakes’ with the killer weed ! For the contrite and famous words like ‘mistake’ and ‘experimenting’ used to be en vogue when describe their drug habits.

  12. phrtao: try again, when I clicked that link I got “Error 404” instead of delicious details about McCartney.

    Bad as it was, what happened to Paul at 64 (last paragraph above) doesn’t compare with what happened to John when he was 64. Right! Lennon had reached the age of 60 days, 4 decades the exact day the fat security guard a$$hole from Honolulu gunned him down.

    Did you know in 1972 the Nixon administration spent $200,000 on lawyers trying to keep Lennon (and Lennonism) out of the USA? (They feared he would mess in the ’72 election and screw things up for Tricky Dicky.) Their main arguing point was some years-earlier minor arrest for Cannabis Possession.

    In 1980 a woman named Carol White toured the talk shows with a book titled “The New Dark Ages Conspiracy” based on theories of her mentor, famous and beloved Lyndon H. LaRouche Jr., that “the British Empire” was trying to smuggle “drugs” into the US to “ruin America’s youth.” During appearances she dropped little gems like, “Marijuana rots your brain.”

    Wait, who was the most famous Brit in the US at that time?? Some guy with a name similar to “London”? (Thou shalt have no other Lyndon before me…) (New Dark Ages ==> You, Mark David (Chapman…)) (New Dark ==> New York…) (Dark Ages ==> Dakota…)

  13. Sorry about the link above – The bracket got tagged onto the end of the link. Not rocket science to correct it but here is a working link with no bracket !

    http://www.10zenmonkeys.com/2007/01/03/paul-mccartney-on-drugs/

    I once tried to make a playlist of music from my (30,000+ tracks) itunes library with no Drug users (including alcohol) and No sexual deviants – Just when I thought I had a nice Cliff Richard compilation some one pointed out the obvious. Try it and see who you come up with. I fail to see why anyone is ever interested in what musicians say or do surely it is they music they make that counts.

  14. Sativex was never meant to be released to the general public, it was only ever approved so that the UK gov could say that the was an alternate to cannabis and its down to your doctor to prescribe it and for you to pay for it.
    I tried to stop it coming to market as I knew that this would happen once the full picture of sativex development and manipulation of MODA over the 10 or so years of development and eventual testing of the plants was clear but alas even that wasn’t picked up on nor the skunk development by gw and dutch breeders.
    But im just a crazy man who uses cannabis for mental health problems so its all in my head…. or is it 🙂

  15. Good Afternoon Mr Brokenshire

    I am writing to you with regards to the current process of the scheduling of Sativex a whole cannabis extract used in the treatment of pain and MS spasticity.

    As I understand the ACMD has recently put forward a request to have Sativex moved from a schedule 1 drug that has no medical use to a schedule 4 drug that has many uses in the treatment of the Human ECSN.

    I understand that one of the concerns of the government is that in rescheduling Sativex to a useful drug with medical value will leave the way open to further legislation regarding the medical use of cannabinoids.

    What I would like to know is when can we expect a fair and just ruling on this classification as there are many sick and disabled people in the UK that need to be lifted out of criminality for using a plants extracts that are now known the world over to alleviate many of the symptoms of these illnesses, but for whom pharmaceutical drugs are either unacceptable due to risk of further illness or shortening of life.

    Many thanks for your time

    John Ellis

    Medical Cannabis user

  16. @John

    The one line that stuck out in that response is “There is real public concern about the potential mental health effects of cannabis use”… that pretty much sums it up doesn’t it i.e ‘we are too scared about public/media backlash to make a sensible and pragmatic policy’…

  17. Thanks Jake for catching that…

    A word to the two-eyes: Gawd hath created WIKI-LEAKS so that “someone” can now proceed to sleuth out and expose the true line of transmission of funding from Big 2WackGo down to and through governments and politicians and their campaign staffs, in respect to how “real public concern about the potential mental health effects of cannabis use” can be and is whipped up, so that

    a. domineering authoritarian family heads will scarewarn their children into anxiety-based psychosymptoms which are poised and ready to “occur” when said children, responding to challenges to muster the courage, experiment with cannabinoids in “joint” combination with heat shock, carbon monoxide, niggatine tobacckgo and other contaminants which

    b. produce scary results the children themselves will erroneously attribute to the cannabis and thus become believers in their own psychic imprisonment and wind up even someday voting for pseudoconservative gaolerpols.

  18. I’m a 58yr old man. I have smoked Cannabis for 43 yrs. I smoke roughly 40 – 50 cigarettes per day, I have smoked cigarettes since I was 13yrs.
    I have always had a bad chest, even in my childhood (long before my addiction to tobacco)

    Unsurprisingly I have developed Emphysema,as a result I want to give up the cigarettes. However as far as cannabis is concerned, I steadfastly refuse to give up something that brings both benefit and relief. Hence my problem is not the substance, but rather it’s carrier Tobacco.

    I’m off to the Doctors next week, I intend asking to be prescribed Sativex on the basis of harm reduction.

  19. @Sendero:

    Based on a figure of 9.1 puffs per $igarette I saw in an ad, you’re taking 364-455 doses of the same drug cocktail per day and still not getting results against the chest problem. Well…

    a. I guess Sativex is fine if you can afford it (huge ripoff prices), meanwhile,

    b. Have you checked out E-Cigarettes (all kinds offered on line for GBP-30 or less) to get any nicotine dosage you want without combustion poisons?

    c. Alternatively if you can afford all those $igarettes you can afford a Volcano! (I think they’re under GBP-400, check it out.) Unlike an E-Cigarette which vapourises from liquid formula in a replaceable cartridge, with a vapouriser you can put the actual dry weed inside.

    d. Check Wikipedia: “One hitter (smoking)/Vaporizing with a one hitter” for description and pictures of mini-pipes TOO SMALL to put both the cannabis and tobacco in– and try single 25-mg. tokes of now the tobacco, now the cannabis (as Derek says in “Toke Pure”, the key is to break the connection).

    e. Check wikiHow.com: “How to Make Smoke Pipes From Everyday Objects” to find out ways to help 20 or 200 deserving friends with their first utensil if they’re too cheap to buy something as above.

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