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Cannabis: Select Committee Report

8.4 p.m.

Lord Perry of Walton rose to move, That this House take note of the report of the Science and Technology Committee on Cannabis: the Scientific and Medical Evidence (9th Report, HL Paper 151, Session 1997-98).

The noble Lord said: My Lords, although I used to be a pharmacologist I knew very little about cannabis when I was invited to be Chairman of this inquiry. Since then, I have learnt a very great deal from those who gave written and oral evidence. It was a fascinating experience.

I am enormously indebted to my colleagues on the sub-committee who gave unstintingly of their time and their skills. I am especially indebted--as we all were--to our specialist adviser, Professor Leslie Iverson, for his experience and expertise and for the work that he did with outside organisations. It almost goes without saying that our clerk, Andrew Makower, and his staff gave us their usual invaluable assistance.

I want to start by pointing out that the members of the sub-committee were completely unanimous in their recommendations. Also, the members of the Select Committee on Science and Technology were equally unanimous in endorsing the recommendations of the sub-committee. I do not think that this opinion--the opinion of two groups, which include quite a number of distinguished scientists and doctors--can be ignored. Nor do I think that it deserved to be dismissed out of hand by the Government on the very day that the report was published. I shall return to this point later.

Let me first describe the structure of the report. It starts with an introductory chapter describing the reasons why we undertook the inquiry. In the second chapter, we give a history of the use of cannabis over the years. It was first referred to in Assyrian tablets

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2,600 years ago and it has been in continuous use since then in Asia, the Middle East and Europe. It was included in the Herbal, the pharmacopoeia of the time, of Dioscorides in Greece in about 60AD and was still included in the British pharmacopoeia of 1914. It is, indeed, said to have been used by Queen Victoria for period pains. Like all herbal medicines, it was recommended for a wide variety of illnesses for which it was virtually useless, but for some few it may well have had an effect.

In 1968, after the tragedy of Thalidomide, the Medicines Act was passed. This led to a system of licensing new drugs for use, imposing strict safety and efficacy requirements in addition to the quality controls imposed by the pharmacopoeia. These tests, including clinical trials, work well with new synthetic chemicals. They would not have worked with the herbal remedies such as the extracts of digitalis and raw opium which preceded them.

After a series of legislative changes, promoted by the rapid growth of the misuse of psychoactive drugs in the 1960s and 1970s, the current Misuse of Drugs Regulations 1985 became law. It classified controlled drugs either in Schedule 1, which banned their prescription altogether, or in Schedule 2, which permitted prescription by doctors for named patients. Heroin, which had well-known medical uses, was put in Schedule 2. Cannabis, however, because it was held at the time to have no known therapeutic value, was put in Schedule 1, although it was much less toxic than heroin. Had the pharmacological activities of cannabis been discovered at that time, this decision might well have been different and we would not have the problem we have today.

In Chapter 3, we describe these recent pharmacological discoveries. First, we describe how cannabis consists of a family of 66 chemically related cannabinoids plus some 400 other substances. Its main psychoactive ingredient is 9 - Tetrahydrocannabinol, or THC for short. Cannabinoids are insoluble in water but soluble in fat. This limits the number of possible formulations for their administration. Smoking cannabis gives very rapid absorption, virtually in seconds. Administration by mouth leads to slow and irregular absorption and much cannabis is degraded as it passes through the liver.

The recent work that I referred to shows that there are receptors--specialised molecules--that are activated by cannabis. One set of receptors is in the brain, another in the immune system. There are also naturally occurring compounds in the brain that activate these receptors. They are called endogenous cannabinoids. Activation of these receptors leads in animals to potentiation of the action of morphine so that a smaller dose becomes effective. In the light of this new evidence, it is difficult to believe that cannabis has no therapeutic value since large doses of morphine not only relieve pain but also depress respiration--and cannabis, by allowing the use of a smaller dose of morphine, would help to prevent this.

In Chapter 4, we examine the evidence about the toxic effects of cannabis. There are two physical effects. It causes a mild increase in heart rate and a fall in blood

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pressure. This would affect adversely only people with heart disease. The second physical effect is on the lungs if the cannabis is smoked. There is in regular smokers of cannabis an increased incidence of cough, bronchitis and asthma and, possibly, of pre-cancerous changes. There has as yet been no case of cancer of the lung, but it seems a fair bet that this will happen once people have smoked cannabis for long enough. Cannabis smoke contains all the carcinogens and as much tar as does tobacco smoke.

The other toxic effects are all psychological. In the short term, there is impairment of psychomotor function. This may affect driving, flying or operating machinery. But unlike alcohol, cannabis seems to make drivers careful rather than over-confident. Cannabis occasionally causes a psychotic episode lasting a day or two, but in the longer term heavy users can certainly develop severe cognitive changes and can become permanently stoned and incapacitated. This may happen in up to 5 per cent. of regular heavy users. It is not seen in those who use cannabis for medical purposes. Similarly, heavy users can exhibit tolerance of and physical dependence on the drug. It can also exacerbate schizophrenia in patients already affected by that disease.

All in all, the evidence shows that, on the one hand, cannabis does have serious toxic effects after heavy and prolonged use for recreation. But, on the other hand, it is easy to exaggerate its dangers when used medically. It has never caused death. It is easy in most cases to give up its use. It has fewer and less serious side effects than most of the active drugs used in modern medicine.

In Chapter 5, we review the medical uses of cannabis. Since all use is illegal, it is very difficult to obtain firm evidence. Nevertheless, we were impressed by the sheer volume of the anecdotal evidence for its successful use in treating the distressing symptoms of multiple sclerosis, and by the experimental evidence for its use in treating intractable pain. We found the evidence for its usefulness in treating epilepsy, asthma and glaucoma less convincing.

The British Medical Association of 1998 estimated that there were many thousands of users of cannabis for medical purposes. The Multiple Sclerosis Society estimated that at least 1 per cent. and possibly many more of the 85,000 sufferers from multiple sclerosis used cannabis illegally; that is, at least 1,000 patients. The Alliance for Cannabis Therapeutics has records of more than 200 patients who benefit from cannabis. In a postal survey of more than 100 patients, 90 per cent. reported alleviation of symptoms, especially of incontinence, muscular spasms and pain.

We warmly welcome the planned clinical trials of cannabis and the cannabinoids for both multiple sclerosis and for intractable pain which were announced during our inquiry. Indeed, our first recommendation is that such trials should be promoted as a matter of urgency. Both trials will, however, use cannabis and cannabinoids by mouth, not by smoking.

In Chapter 6, we discuss the use of cannabis for recreation. It is estimated that one in three of all those aged between 16 and 29 have tried smoking cannabis at

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least once and that 7.5 million people in the UK have smoked it at one time in their lives. We felt, however, that the potential toxic effects of heavy and prolonged use were such as to justify maintaining the policy of keeping cannabis as a controlled drug.

In Chapter 7, we discuss the effect of changing the law about the medical use of cannabis. On the one hand, we agree with the Government that, to get a licence from the Medicines Control Agency there must be a standardised preparation of cannabis or a cannabinoid that is of approved quality and that has been tested by clinical trials for its safety and efficacy. Furthermore, we agree that any such licensed product should not be administered by smoking. On the other hand, we know that clinical trials will take at least five years to be completed. Was there any way that patients could be given cannabis legally without waiting for a licensed product?

It is indeed already possible for a doctor to prescribe THC because THC is in Schedule 2. This itself is anomalous since it is thereby held to have therapeutic value while cannabis, which contains it, is held to have none. Yet many users find cannabis more effective than cannabinoids in relieving their symptoms. Thus there is a logical argument why cannabis should be in Schedule 2. There was, as I showed earlier, an historical argument for it. We also felt that there was sufficient evidence of its safety in medical use, and of its efficacy, albeit anecdotal, in multiple sclerosis and for intractable pain for it to be so transferred. This was our main recommendation.

Finally, let me turn to the consequences of such a move. Doctors and pharmacists could manufacture and prescribe cannabis legally. The doctor could prescribe it in any form he chose--for oral administration, for smoking or for administration by any other route. We do not approve of smoking cannabis over a long period because of the potential risk of cancer. This is clearly, however, of no importance in patients dying from terminal cancer or AIDS. It is at least arguable that if one suffers from the distressing symptoms of a chronic disease for which there is no known cure, one would put the advantages of a better quality of life ahead of the misgivings about the potential risk of cancer. That is not to argue against the desirability of finding an alternative way of achieving rapid absorption without smoking. Indeed, we recommend that research to that end be promoted. It was recently reported that an aerosolised extract of cannabis will be used in one trial. That is, however, to put compassion ahead of anti-smoking principle.

I return to the fact that the Home Office Minister in the other place saw fit to reject our main recommendation on the day that the report was published, in the following words:


    "The Government would not be prepared to countenance any move to allow prescription before clinical trials and safety tests have been completed. The safety of patients is our first priority and the Government would not allow prescription of any drug which had not been tested for safety, efficacy and quality through that clinical process.".
Even if we accept that patient safety is the first priority, our report shows that if cannabis is used to treat patients on the prescription of a doctor, the risk to the patient

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is vanishingly small. Furthermore, many patients would regard their safety as only their second priority after the quality of their lives. Should not the Government share that view? Is their attitude coloured by social, economic and criminological considerations to which our inquiry was not addressed? Those considerations are only pertinent to the recreational use of cannabis and should not be allowed to influence decisions about its use for medical purposes. The well being of patients ought to be paramount.

I call on the Government to give more mature consideration to our recommendations. I beg to move.

Moved, That this House take note of the Report of the Science and Technology Committee on Cannabis; the scientific and medical evidence (9th Report, HL Paper 151, Session 1997-98)--(Lord Perry of Walton.)

8.22 p.m.

Lord Winston: I thank the noble Lord, Lord Perry of Walton, and congratulate him on chairing the committee in such an excellent manner. The committee sat for eight months and it was a pleasure to be part of those serious deliberations under the noble Lord's chairmanship and with the advice of Professor Iversen of Oxford. I thank also, as did the noble Lord, Andrew Makower, the Clerk to the Committee, who made its members swear a vow of chastity and silence over whether they had ever partaken of cannabis themselves.

This excellent report is modest in its remit and recommendations, and extremely contained and confined. It states simply that it is seriously important to consider the therapeutic applications of a potentially useful drug and that the drug may give some insight into neurological transmission because of its curious actions within the brain and the rest of the nervous system.

Control of pain is not an easy matter. There never has been and, I suspect, never will be a single drug that will control pain--particularly where it is neurogenic in origin.

Because the report is limited and the committee's aims objectives and considerations were constrained, this debate may be repetitious.

The British Medical Association, in the briefing that some of your Lordships may have seen, perhaps erroneously gave the impression that the committee did not distinguish between cannabis and the cannabinoids. That is untrue. We did make that distinction. We understood the difference between a pure form of the drug and a dirty drug--a drug having just the active compound or one that is contaminated. There is nothing wrong about using a dirty drug if it going to do the job. We use such drugs all the time. For the past 20 years, my own practice has been using FSH--follicle-stimulating hormones--which is not pure but derived from human sources. It has all sorts of proteins in it that are not wanted and which have unwanted effects. But until the recombinant drug was available this year, that was the only way we could stimulate ovulation. We did so successfully and many thousands

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of babies have been born throughout the world without serious problems. So clean versus dirty drugs is not the issue. The principle of the use is key to the argument.

Are cannabis and cannabinoids so dangerous and potentially so devastating as to be more carefully and rigidly restricted than virtually any other drug--including methadone, morphine, cocaine and heroin? The answer must surely be no. Cannabis may have some rare dangers, possibly including cancer, neurological damage or psychological damage in certain susceptible individuals--but those risks are clearly much less than with many other drugs. Despite anecdotal claims, there is little evidence that cannabis will cause schizophrenia--although people who are predisposed to that condition, either genetically or for other reasons, may develop it during extensive use.

It is clear that toxicity of the compound is extremely low, causing perhaps four or five deaths in the past few years. Aspirin kills perhaps 50 people annually and so does paracetamol, which is widely available and can be bought over the counter at any pharmacist. Alcohol is responsible for far more deaths than any of those painkillers.

None of those limitations or worries about risks applies to carefully supervised risks. Many witnesses gave evidence of potential benefit. It seems that the few cannabinoids that are available in Britain on prescription have a limited effect on patients with the sort of pain that we are talking about. The patients in question are often desperately ill and dying of disease, and for them we must have great sympathy. Our report simply calls for proper evidence about the use of such drugs. We are not asking for recreational use. There is not the slightest evidence that, given proper controls, the implementation of our recommendations would increase recreational use in the slightest. Even if it did, there is no serious evidence to suggest that the consequence would be as dangerous as the misuse of existing drugs such as aspirin. The committee recommends that cannabis and allied compounds may be given by doctors orally, by pessary, by suppository or by another appropriate method on a named-patient basis. That would be the most modest change possible in the law.

It is disappointing that my honourable friend the Minister, who is a good and excellent Minister and a thoughtful man, was reported as saying that, essentially, the Governments position is inflexible. One report quoted him as saying:


    "It would be irresponsible to say that it's OK to use it but there is no scientific evidence that it will work".
That is always the dilemma faced in the use of any drug. One actually has to test it. It is equally irresponsible, if not downright hard-hearted, not to offer such drugs if there is the slightest evidence that they might work.

We need clinical trials. However, the Government's response issued within hours of this report being published was,


    "We have not got rigorous scientific evidence that gives us absolute confidence that it is actually beneficial".
That is our position. That is exactly what we are trying to establish; namely, evidence that these are beneficial drugs. As we have reported, that cannot be done with

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the rigid controls that are currently in place. We need blinded, controlled, possibly crossover studies--standard pharmacological methods of examining drugs. That simply cannot be done with the current regulatory position. It is interesting to note that the proper use of these drugs could improve our understanding of the nervous system.

Currently we have a ludicrous catch-22 situation. I fear that the Government's response on this occasion was too hasty. It was an understandable knee-jerk reaction, but I fear that it is wrong. This is a serious committee whose membership comprises Fellows of the Royal Society, a Nobel prize winner and other distinguished members. If the Government are not prepared to take serious notice of this committee and are not carefully to consider its findings, it has to be said that perhaps there is no point in such a committee sitting at all. To ignore the careful and well-considered findings of such a committee would diminish an important function of your Lordships' House. It could also damage the esteem and respect in which the Government are held.

8.31 p.m.

Lord Dixon-Smith: My Lords, I must admit that there were times yesterday afternoon when I thought perhaps I might be high on a cannabis trip! Fortunately I knew that that was not the case.

I undertook this study with a considerable lack of enthusiasm. I could not become interested in the subject. However, by the end of our deliberations I became fascinated by the subject and I learnt a great deal about it, as one so often does on these committees. It is one of the great privileges of taking part in such committees that one gains insights into subjects of which one formerly knew absolutely nothing. I am most grateful to the chairman of the committee and to the other members for tolerating me. I echo the disappointment of the noble Lord, Lord Winston, at the Government's apparent immediate rejection of the report. I hope that they will give the matter more mature consideration and will consider seriously the rather limited but specific and deliberate recommendations of the committee.

This is an unusual report as a large part of what we have recommended depends on what is essentially anecdotal evidence. We had to spend some time arguing about the nature of evidence and whether anecdotal evidence could be considered to be scientific evidence, and, if it was not, whether it could be considered to be evidence, and if it was not evidence, what was the point of hearing it anyway. Some 2,500 years of use of this substance must suggest something.

There is another aspect of the report I wish to mention; namely, that we do not recommend that something be made available for use which is not already available for use. It may be all too regrettable, but cannabis is virtually freely available, provided one can afford it. The price is not particularly high but undoubtedly the desire to possess the substance leads to a certain amount of criminal activity. However, for those who need it, cannabis is available. The report seeks to make legal what is at present illegal for those in

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desperate need of it. We need to bear that distinction in mind. For some individuals, such as those who suffer from multiple sclerosis, cannabis is the best pain reliever they can have. It is good for pain relief and it is good for spasticity.

There is the recommendation to reschedule cannabis out of schedule 1 into schedule 2. That matter apparently will have to be considered by the World Health Organisation. I find it fascinating that a small change can have such wide implications. If it is accepted that cannabis can be prescribed by doctors on a named patient basis for a defined condition, then surely we are not doing anything to endanger the social fabric of society at large through a possible leakage into the general community that may occur as a result of that action. The idea is preposterous when one can buy a small amount of cannabis on any street corner if one wishes to do so. In any event the evidence we heard suggested that where legal action was taken for this offence, the courts treated those cases compassionately and they were generally discharged. I am immensely relieved that that is the case. I believe it would be grossly wrong if that were not the case. However, we have to deal with what is in effect an inconsistency in the administration of the law.

The chairman has already mentioned my next point; namely that the cannabis plant contains 66 separate cannabinoids. The evidence suggests that they work in combination and not individually. Rather like the vine, the make-up of the cannabis plant seems to vary with climate, geography and the system of cultivation. Cannabis is an immensely complex plant. Although it is wrong to use this comparison, I compare the cannabis plant with the vine. Two vineyards in separate locations will produce two dramatically different wines from exactly the same vine. One has to take into account that variation with regard to cannabis.

It seems to me that there are two ways to research this matter. One is to produce a standardised, consistent product which, of course, can be done by cloning plants. One then examines what effect that product has. The other way is what I call the lottery approach to research; namely, one recognises that there are 66 substances working in combination and one identifies each one and examines them. One then tries to sort out the ideal combination. Every week in this country the National Lottery is held with permutations of 50 numbers. Every week one or perhaps two people have the correct numbers. It seems to me that to apply that kind of approach to a critical examination of 66 separate cannabinoids is an immensely hazardous operation which is not likely to lead to quick success.

People with certain conditions need immediate relief. We believe five years of research may be needed to begin to discover in scientific terms the medical effects of cannabis. However, if we take the long route, we are not talking about five years but about a lottery. I do not think that is satisfactory. An MS sufferer needs something which gives immediate relief. MS sufferers have a condition which goes downhill from one plateau to another over the years. If their quality of life can be improved, that is worth doing.

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In this regard, the method of application is critical. Cannabinoids dissolve very quickly in fat. Taking them orally is not very effective. It appears that pessaries are more effective, but all the evidence that we received was that smoking is the most effective way to dose with cannabis. One takes the smoke into the respiratory tract; it goes straight into the blood and then straight to the brain, where it acts, as the noble Lord the chairman of the Select Committee said, on the appropriate receptors and the pain is relieved. Relief is quick, but, on the evidence that we heard, not instantaneous, although one does not need to smoke even half a cigarette, in many instances, before pain is killed. The sufferer then stops smoking until the pain unbearably reasserts itself.

Each individual is different. Some will need a bigger dose than others. There is no way in which a standard dose will work. In all humanity, I conclude that if the choice is between insufferable pain, which is what these people are enduring, and smoking (with perhaps the risk of cancer 25 years down the line), I think that smoking is the tolerable alternative.

Considering all that, the committee still came to quite a clear view; that there could be no reason for relaxing the general restriction on recreational use. That was clearly stated in the report. It seems to me that in all humanity we should accept the recommendations of the report. I am glad to support the noble Lord, Lord Perry of Walton.

8.41 p.m.

The Earl of Carrick: My Lords, I would like to start by saying how deeply impressed I have been witnessing your Lordships' House at work. Surely if all politics could be conducted with the same unfailing courtesy, care for detail and sheer commitment, society would be all the richer. I would also like to take this opportunity to thank the Officers of the House for their kind helpfulness from the moment I arrived last year.

It was with some trepidation that I put my name down for this debate and I sincerely ask for the indulgence of the House because I have chosen a subject for my maiden speech in which it is hard to say anything meaningful without being in some way controversial.

I was fascinated by the Select Committee's report on the scientific and medical evidence on cannabis. I shall not pretend to understand it all as I am neither a scientist nor have any medical knowledge, but certainly I have learnt plenty.

First, I should like to take this opportunity to say a few brief words about the whole question of drugs in general. I know that this is wide of the specific debate, but I believe that the subject is of vastly greater importance, economically and socially, nationally and internationally, than is reflected by the time and attention given to it by legislators.

I was staggered to read that in June last year the United Nations drug control programme estimated that the world trade in illicit drugs now stands at one quarter of a trillion pounds, which is to say, it accounts for 8

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per cent. of all international trade, making it of greater economic importance than international trade in iron, steel or motor vehicles.

Of course, it is a fiendishly difficult problem where there are no right answers, which goes a long way to explaining a natural reluctance to confront the issue in the detail it demands. But it will only be through the most detailed discussions, with open minds, that progress will ever be made.

What we can say is that that quarter of a trillion pounds of world trade manifests in all manner of undesirable social consequences and costs. Unfortunately, the same old actions and attitudes that have failed--indeed, are likely, ironically, to be contributory to that failure--still hold sway, yet no matter how many resources are mustered, the problem gets worse.

We desperately need fresh thinking. So my first point is simply a heart-felt plea that greater time is given and action taken to make the situation better.

An editorial in the Lancet recently noted, echoing what we have heard from the noble Lords, Lord Perry of Walton and Lord Dixon-Smith, that,


    "The desire to take mood altering substances is an enduring feature of human societies world-wide and even the most draconian legislation has failed to extinguish this desire ... and this should be borne in mind by social legislators".
Amen to the latter.

Speaking of our law-makers, to my mind one of the most important points, which is a legal and social one, rather than scientific or medical, raised in the document we are debating came in Chapter 8, where it states:


    "If statute law is not enforced, Parliament is brought into disrepute; either enforcement must be tightened up, or the law must be changed".

Austin Mitchell is quoted in similar vein, when in response to the fact that people who use cannabis for medical purposes face prosecution if caught cultivating or possessing cannabis, he was prompted to say:


    "It is bringing the law into a certain amount of difficulty and disrepute because either the police are cautioning or the courts are giving very lenient sentences".

This is indeed a dilemma for any government. If there are, as the report estimates, 7.5 million adults who have tried cannabis--approximately one-sixth of the entire adult population--and between 1.5 million and 2 million regular users, it stands to reason that legal foundations are being severely undermined. Either society is making a mockery of the law by disobedience on such a massive scale, or the law is making a mockery of society by criminalising over half a million people over the past 25 years, with all the attendant problems that implies for the individuals concerned.

Surely common sense tells us something is deeply awry here. Again, I return to my main point: all these issues must, for the good of us all, be given proper time for research and discussion with unprejudiced thinking.

Finally, turning to the purely medical aspects of the report, my abiding impression is that there are compelling reasons for further detailed medical study of what appears to be a source of enormous potential to ease suffering. A substance that, even in its crude form,

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can be used with unquestionable effect--although to differing degrees--to help sufferers of MS, cerebral palsy and glaucoma, surely demands attention and study. Add to that anti-emetic effects, analgesic properties and the ability to assist prevention of weight loss in anorexia, cancer and AIDS and we have a substance already of value.

No matter that in some cases there are better drugs currently available: the fact that cannabis has such a wide range of beneficial effects is extraordinary. Even if my understanding is far from that of a scientist, it is strikingly obvious to me that Professor Wall is right when he says (in Chapter 4):


    "It is a paradox that a subject of such intense scientific interest should receive so little clinical attention ... this is regrettable since there is a wide range of possibilities and massive opportunities for research".
Add to that, Dr. Robson's (in Chapter 7) remarks that:


    "The present licensing system and policy has severely limited research and should be reviewed",
prompting the observation that the United Kingdom's academic community and pharmaceutical industry may miss the opportunities if the research licensing regime is not relaxed.

Given the high standing of our academic community and our world-leading pharmaceutical firms, this is surely unwise. It is noted in the report that the United Kingdom's attitude towards cannabis is one of the most restrictive in the world, so too many other countries are being allowed a head start. Surely in this, as in most matters, the government of the day must strive to provide an environment for intellectual clarity and business advantage.

To me, the authors of the report are motivated purely by a compassionate wish to allay human suffering and a proper desire for unfettered scientific exploration of cannabis in all its component forms. On that basis, I wholeheartedly support the Select Committee's specific recommendations.

8.48 p.m.

Lord Kirkwood: My Lords, it is my pleasant duty to congratulate the noble Earl, Lord Carrick, on his excellent maiden speech and wise words. We hope to hear a great deal more from him in the remainder of his shelf-life, as he is, like me, an hereditary Peer.

First, I should declare that I too was a member of your Lordships' Select Committee which, under the able chairmanship of my noble friend Lord Perry of Walton, inquired into cannabis and produced this report.

The report's recommendations are few in number. They are brief and succinct. Some refer to the need for proper clinical trials of cannabis and alternative modes of administration of the drug. We have recently learnt that such work has already started with the grant of a Home Office licence for the cultivation of cannabis plants of known provenance, grown under carefully controlled conditions to produce a drug of reliable consistency. All that is to be welcomed.

The most radical and controversial proposal, however, has been greeted by the Government with distinct coolness and, as the noble Lord, Lord Perry,

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said, almost instant dismissal by the Home Office Minister. I refer to the rescheduling of cannabis from schedule 1 to schedule 2, from a position in which it cannot be prescribed by a doctor for a patient as a medicine for the relief of distressing symptoms such as pain, nausea, muscle spasms and so on, to one in which it is permissible on a named-patient basis.

It has to be said that in making such a radical change one must be careful not to send out the wrong signals. There is evidence that the abuse of cannabis can lead to health problems, particularly if it is smoked, and in some cases psychological disorders. For those reasons the committee could not support the general legalisation of the drug--and the rescheduling recommendation has nothing to do with that. On the contrary, by clearly distinguishing between the therapeutic use and the recreational use of cannabis, the committee believes that the problem for the law enforcement authorities of tackling abuse should be made easier.

The Government maintain that they need hard scientific evidence as to the efficacy of natural cannabis as a drug before they can act. But there is ample evidence, and ancient evidence, that relief is obtained by people who are suffering pain even using small dosages of the drug, and in many cases relief comes rapidly. Admittedly, the evidence is anecdotal, not hard scientific fact. But at present people are willing to break the law and run the risk of being prosecuted, with all that that entails, because they can find relief for their condition in no other way. In many cases their GPs are sympathetic to their practice.

There is no question that the whole situation is highly unsatisfactory. People who are normally law-abiding citizens are being made into criminals, and the illegal drug trade profits from selling cannabis of unknown and possibly harmful quality. Certainly there is a need for properly controlled research into the benefits and hazards of cannabis use, and thankfully that has now started.

However, it is estimated that it will take at least five years before sufficient trials have been carried out and for the Medicines Control Agency to recommend to the Government, if the results are positive, the rescheduling of the drug. In the meantime, 85,000 people in this country will be left to suffer, some in great pain, and perhaps needlessly.

It all comes down to the need for hard evidence. As Professor Joad might have said, "It all depends on what you mean by hard evidence". I work as an experimental scientist, and I am fully aware that evidence for many scientific conjectures is often slight. One-hundred per cent. certainty in science does not exist, although many scientists would suffer martyrdom for their belief in the laws of thermodynamics. Certainty in the medical sciences is even more tenuous, because they deal with notions such as pain and its relief where rigorous objective testing and measurement are difficult. Often we have to act where we have less than certainty, even while we endeavour to improve our knowledge.

I urge the Government, in this situation, while they strive to encourage further research, also to feel compassion for those sufferers--often from terminal

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illnesses--and also to show courage in facing the inevitable reaction of those who talk about a small step opening the floodgates to wholesale drug abuse, to allow doctors to provide this relief to those suffering the distressing symptoms of multiple sclerosis, AIDS and terminal cancer, by allowing the prescription of the drug in a controlled manner and on a named-patient basis.

8.55 p.m.

Lord Porter of Luddenham: My Lords, it has been a privilege to serve on your Lordships' sub-committee on cannabis, under the wise and expert chairmanship of the noble Lord, Lord Perry of Walton. The problems that we discussed were largely medical, and the committee had no shortage of expertise in this area since half of its members, six out of 12 including its chairman, as well as its specialist adviser, are medically qualified, all of them very distinguished in their field.

We had experienced advice in some of the other areas which bore upon our problems, such as the law and the special problems of prescribing by general practitioners. We also owe much to the committee's Clerk, Andrew Makower, for his drafting skills in preparing an account of our views which we could all accept--not an easy task.

I am not medically qualified, and speak only as a chemist. In that capacity I noted with interest and pleasure that the chairman of your Lordships' first committee on science and technology, in 1979, was my noble friend Lord Todd. Even more to the point, when he was a professor of chemistry in Manchester and at the Lister Institute, he carried out some of the earliest research on the chemical composition of the active components of cannabis. If noble Lords will allow me to introduce just a little levity into what is of course a very serious matter, they may be interested in Lord Todd's encounter with the Home Office and his own possession of cannabis.

In 1936, Professor Todd went to the Lister Institute, where, among other biochemical problems, he began work on the active principle of cannabis sativa. The starting material for his studies was a distilled resin extract of hashish which had been seized by the police in India. It was obtained from them by a chemist, Fritz Bergel, who transmitted it to Germany in the diplomatic bag and thence in a suitcase to Edinburgh through the port of Leith. The Customs showed no interest.

In the Lister Institute, Professor Todd isolated cannabinol (not tetrahydrocannabinol, which is the active component) from the resin and showed that it was pharmacologically inert. That work was published in Chemistry and Industry ("Blue Bits" as we used to call it) and within a few days some interest was shown--by the Home Office! They invited Todd to meet their inspector at his earliest convenience.

When asked where he got the hashish, he had to reply, "from the Indian police". "How much of the stuff have you got?". At this point his answers became even more startling: "Two-and-a-half kilograms". "Good God!", exclaimed the inspector. But he recovered his poise and agreed to make Todd a licensed holder of cannabis on

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condition that the professor would send 25 reprints of his publications. "Certainly. Where shall I send them?" asked Todd. "Send them to me", said the inspector, "at the bureau of drugs and indecent publications".

Today the Home Office seems to be less liberal in these matters. Indeed, as we have heard, within hours of receiving the report of your Lordships' committee on cannabis, with its recommendation that, for the time being, cannabis should be transferred from schedule 1 to schedule 2, the Minister had made up his mind to do nothing of the kind. This was known to be the most controversial of our recommendations, but it was made after taking evidence lasting some seven months, and it was unanimous. The government reply to our earlier report on antibiotic resistance took eight months to arrive, which is much too long, but at least the Minister had time to read it.

I confess that personally I have found it difficult to decide on this matter. As a chemist, I have no difficulty with the prescription and trial use of well-specified pure chemical substances such as cannabinoids, whether synthesised or extracted from cannabis resin. But the medico-chemical study of a natural cannabis of variable composition containing more than 60 cannabinoids and several hundred other chemical compounds is, to put it mildly, a daunting research project and one which is likely to take a very long time.

There was no doubt in the committee that any relaxing of the regulations on cannabis should apply to medical uses only on prescription. We are all aware that scientific proof of safety is not available and probably will not become so until after five or more years of clinical trials.

In spite of the difficulties, we regard the clinical trials which are being launched by the Royal Pharmaceutical Society as the first priority. If these are to be licensed, further research will be necessary into new, safer methods for delivery, such as inhalation, which was referred to by the noble Lord, Lord Dixon-Smith, and others. Until these are successfully completed, however, we believe that, on compassionate grounds, as well as removing restrictions which bring the law into disrepute--which is almost equally important--justice would best be done by the rescheduling of cannabis so that, like its active ingredient 9 -tetra-hydrocannabinol, and like cocaine and morphine, it could be prescribed on a named-patient basis, to relieve the pain of sufferers from, for example, multiple sclerosis. Genuine users for medical reasons could then be distinguished from recreational users simply by producing their prescription.

In conclusion, we heard encouraging evidence from our witnesses of new research on the pharmacology of cannabis and how the body contains naturally occurring "endogenous" compounds--to which the chairman of our committee referred--that can activate cannabinoid receptors. There are two known receptors called CB1 and CB2. Only CB1 exists in the brain and CB2 is therefore not expected to have the unwanted pyschoactive effects associated with cannabis, while agonists to CB2 may well have beneficial effects in modulating immune responses.

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As understanding of the brain advances apace, these discoveries have transformed the character of scientific research on cannabis. But, although there is increasing scientific interest in cannabis pharmacology, there is little clinical research or commercial development work at present. Some attribute this to the added difficulties of working with a schedule 1 drug--the Royal Pharmaceutical Society refers to the "burden of licensing". A further advantage of moving cannabis to schedule 2 of the regulations would be that licences for research in this new and exciting area of medical biochemistry would no longer be required. I hope that the Minister will give a little more time to considering some of these matters before he persists with his blanket restrictions.

9.4 p.m.

Lord Mackenzie of Framwellgate: My Lords, I welcome the report of the Select Committee dealing with the scientific and medical evidence on the use of cannabis. I congratulate the noble Earl, Lord Carrick, on his maiden speech, which I particularly welcomed because, apart from myself, he is the only speaker so far who was not a member of the committee. I suspect that, had I been a member of the committee, there might have been one dissenting participant. I do not share the disappointment of previous speakers at the Government's response to the report.

I should perhaps declare an interest, although I have some trepidation about doing so in view of the comments of the noble Lord, Lord Porter. I am the former head of a police drugs squad. I am not a scientist or a medical expert, and I bow to the learned witnesses who gave evidence to the committee. The fact that a law is broken regularly is not an argument for legalising the activity. If it were, we should not have laws against speeding.

I speak from my experience as a police officer dealing with the effects of drug abuse, both on the abuser and on the wider community. Cannabis is an intoxicant--or, more accurately, THC, the active ingredient, is an intoxicant. It alters perception and, as the report says, after smoking, which is the most common way of using the drug, the psychoactive effects are perceptible within minutes. The report reminds us that the drug persists in the brain longer than in the blood, so the psychological effects persist for some time after the level of THC in the blood has begun to decline.

It is my experience from reading--certainly not from personal knowledge--that the THC in cannabis has increased dramatically in the past few years, and there was evidence before the committee to this effect. I have seen reports that in the 1960s it was 1 per cent., whereas now in some products it is almost 30 per cent.

There is evidence that use causes mood changes, loss of memory, psychosis, impairment of co-ordination and so on. The report tells us that no one has ever died as a direct result and immediate consequence of recreational or medical use, and I accept that, although there are doubts in relation to some road accidents. The report points out the dangers of driving a vehicle or flying an aircraft while intoxicated following usage of the drug. I

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believe that liberalisation of the law will increase the number of people who use the drug. In Holland it is estimated that the use of cannabis has trebled since the 1980s when it was decriminalised.

The report points out that cannabis intoxication is difficult to monitor, and that is true. There can be no equivalent of a breathalyser for alcohol since small amounts of the drug continue to be released into the blood long after any short-term impairment wears off. Therefore, for the reasons that I have outlined, I am delighted that the committee endorses the Government's statement in Tackling Drugs that,


    "The more evidence becomes available about the risks of cannabis ... the more discredited the notion that it is harmless".
Recreational use is therefore ruled out quite correctly.

What causes me greater difficulty is the recommendation that cannabis should be transferred from Schedule 1 to Schedule 2 of the Misuse of Drugs Regulations, thereby allowing doctors to prescribe and pharmacists to supply the drug for medical purposes. The committee has in a sense jumped the gun. There is a contradiction. Throughout the report, it is stated that the most common method of taking cannabis is to smoke it. For example, that is why in paragraph 8.4 it is recommended that research be promoted into alternative modes of administration because of the well-known dangers of smoking. Professor Heather Ashton of the University of Newcastle is reported as saying that,


    "smoking cannabis leads to three times greater tar inhalation than tobacco. Chronic use increases the risk of cardiovascular disease, bronchitis, emphysema and lung cancer".
The report itself states in paragraph 5.54


    "... there are anecdotal reports that those who use cannabis for medical purposes favour smoked cannabis over orally administered cannabinoids".

If the authorities change the scheduling of, say, cannabis resin how does the committee envisage users will administer the prescribed drug? I would have no objection at all to pills being prescribed to be taken orally but the report is unclear as to how it is envisaged cannabis is to be administered before clinical trials have taken place. I do not believe that any responsible person would suggest the use of a disease-causing and life-threatening method of treatment in order to alleviate pain and suffering caused by any medical condition. If prescription for smoking were allowed history tells us that it would be abused.

I have often said that the ardent campaigners for the decriminalisation of this drug for medical use see such tactics as a Trojan Horse for the eventual legalisation for recreational use of not just cannabis but all drugs. Having spoken to law enforcement officers in the US, it is apparent that in those states where it has been legalised for medical use it has become increasingly difficult to enforce the law generally. Contrary to the argument of my noble friend Lord Kirkwood that law enforcement would be made easier, the experience in the US is the other way. I believe that we go down that road at our peril.

The Government are surely right to wait until the results of proper clinical trials are forthcoming before cannabis is made available for medical use. Cannabis is

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defined by the United Nations as a dangerous narcotic. It should remain such here until we are properly satisfied by evidence to the contrary. I believe that the response of the Government is absolutely right.


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