PAYING THE PRICE
Seven years after the first cannabis-based pharmaceutical was made available in the UK it is still prohibitively expensive. Nick Thompson asks why
It’s around this time of year that weed smokers get their time in the hazy sun. Cases get put forward, people get high, and then the legalisation chorus dissipates into the background for another year. But cannabis has been available in medical form for seven years now in the UK, though you probably didn’t know that, and that’s emblematic of the issue.
GW Pharmaceutical’s cannabis-derived prescription drug, Sativex, is popular with sufferers of multiple sclerosis, but it’s expensive. In 2014, NICE (the National Institute for Health and Care Excellence) found it not sufficiently effective in treating muscle spasticity for its price. In 2017, it costs £375 plus VAT per pack, roughly 270 doses.
That decision meant the drug, administered as a spray under the tongue, isn’t available in England and Scotland on the NHS. In Wales, there’s limited availability. MS sufferers here are only permitted the drug
to control spasms, not to relieve pain, once they’ve exhausted other medical options.
I had this feeling like my body didn’t belong to me. Rain was painful. Hot water was lukewarm
Why is the first cannabis-based pharmaceutical available in the UK so expensive? Why is it so hard to get? And what does this mean for UK cannabis prohibition?
Caths Evans is a Tumefactive multiple sclerosis sufferer and founder of the Sativex Advisory Group (SAG). Evans tells me how traditional medicines make her feel sick all the time, “like a zombie”. Evans’ condition is characterised by spasms and infrequent strokes, years apart, which have an impact on her mobility, memory and ability to speak.
Sativex – which she’s been prescribed since 2010, luckily predating NICE’s decision – aids her symptoms dramatically. “[Before] I had this feeling down my left side like my body didn’t belong to me… It’s like a tingling sensation; anything cold would be painful on my skin. Rain was painful. Hot water was lukewarm to me. I would take things out of the oven without using gloves; it was quite dangerous for a time.
“But once I started using Sativex, it was amazing! The tingling had stopped almost, the spasms stopped completely. You weren’t out of your head on it; it just made you feel normal.” Crucially for Evans, Sativex is still not half as readily available as it should be due to NICE’s decision, and also because Sativex is only made available for MS sufferers in the UK, though it aids symptoms in other illnesses.
In trials, around half of the patients responded to Sativex, typically in the first few weeks
The price of the drug is unlikely to be an issue of pure unadulterated capitalism. Peter Reynolds, president of CLEAR (Cannabis Law Reform), tells me the main reason the price is so high is because “the process GW had to go through in order to achieve market authorisation is so expensive”.
But according to an MS Trust spokesperson, Sativex has always been scarce: “The local CCG tended to be reluctant to prescribe [pre-2014], though that might have been down to the reluctance of CCGs to prescribe things without any NICE guidance, and they came out against it, which obviously closed it down entirely.” In medical trials, around half of the patients responded, typically in the first few weeks of treatment.
It comes as little surprise to anyone familiar with the pharmaceutical world that the cost of research, development and marketing ratchets up the cost of a drug. The issue is suspect however when you consider Sativex and its counterparts internationally are much more affordable. The difference in the UK, of course, is that possession of cannabis – a controlled, Class B drug – could see you charged under the 1971 Misuse of Drugs Act, although figures suggest an anaemic national police force pursues this course less than ever.
The price likely stems from the added regulatory hoops Sativex must pass through in Britain, as, according to Reynolds: “The exact replica of Sativex can be bought in medical marijuana dispensaries in the States for a tiny fraction of the price that GW Pharmaceutical charge for it,” as they don’t have to comply with the same regulatory procedures.
GW’s vice president of investor relations, Stephen Schultz, argues it’s not the parent company’s fault for
the price discrepancy, nor is it avoidable, as another pharmaceutical company, Almirall, markets Sativex and “each country has its own pricing scheme”. Sativex is not currently available in the US, as it’s not FDA-approved, though it is in phase 3 trialling.
In Reynolds’ view, it’s the procedures the Medicines and Healthcare Products Regulatory Agency (MHRA) and other regulatory bodies use to test new drugs that are the issue. “The whole way Sativex is regulated is fundamentally dishonest. It’s regulated on the basis that it consists of only two molecules: THC and CBD. Whilst Dr Geoffrey Guy, the chairman of GW, is on the record himself saying – I have it confirmed in writing from him – that it contains up to 400 molecules.
“The MHRA and conventional or pharmaceutical medicines regulators are simply not competent, capable of regulating a whole plant medicine. Every other jurisdiction in the world has set up special regulatory procedures around cannabis because it is completely different from pharmaceutical medicines.” In real, consequential ways, GW is trailblazing in a particularly fledgling and legally dodgy area in UK medicine. For Reynolds, it’s all for the better: “I’m a great admirer of GW... I regard them as the people who, at great courage, and at great risk, have broken the UK cannabis prohibition. By playing the Government’s game, by going through the established procedures.”
There’s an inherent tension in GW’s founding motives, in that they recognise the therapeutic value in cannabis, but their niche exists only if cannabis remains prohibited. So it’s surely not in their interests the British Government effects any law change, is it?
Schultz told me the situation in the US disproves that. ”In the US, we don’t see the relaxation of laws around the medical use of cannabis or recreational use of cannabis as really being any significant impact on our objectives. There are those who will use medical dispensary-based marijuana products [in the US], but we believe that most physicians and most patients desire a pharmaceutical medicine,” said Schultz. “Our objective is just to provide that option.”
Speaking with Evans and other MS sufferers, it’s clear Sativex has been incredibly helpful in aiding symptoms such as muscle spasticity, whilst the drug doesn’t bring a host of negative side effects like typical MS pharmaceuticals tend to.
But availability continues to be a fundamental stumbling block for patients in the UK, particularly in
England, and that’s a travesty for those that need it. The drug provides compelling evidence of the medicinal efficacy of cannabinoids, though in the UK at least it hasn’t led to a wider medicinal cannabis framework, but it provides reason to hope.
With Sativex, it’s as if cannabis has been repackaged and delivered in a bottle – arguably to circumvent the Home Office’s blanket denial of cannabis’s medicinal worth – but it still hasn’t been enough. Seemingly thanks to powers beyond GW’s control, Sativex has largely failed to leave its mark seven years on.