Intended for healthcare professionals

Feature Access to Medicines

Medical cannabis: patients turn to private clinics because of NHS void

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5290 (Published 02 September 2019) Cite this as: BMJ 2019;366:l5290

Re: Medical cannabis: patients turn to private clinics because of NHS void

There is a mystifying narrative in this article that states that while NHS doctors follow guidelines (and good prescribing behaviour), those who choose to work privately can simply disregard safety, evidence and the law and give out cannabinoids at will because they know better.

There are plenty of interested groups in the UK pushing for medical cannabis on prescription but in the face of anecdote and commercial pressure the job of doctors and the BMJ is to use scientific evidence as the bedrock of good prescribing practice and balanced journalism respectively. NICE has produced its guidance because it has looked at the evidence, and the NICE guidance ought to be the underpinning message here. Instead your article reads as a puff-piece for interested concerns who stand to make money and reputation from cannabis. You may think you have created balance by detailing the extensive commercial conflicts of interest of your two cannabinoid promoting interviewees, but that simply reads as two pages of free advertising for Drs Sodergren and Barnes. Well done them!

For your information, if cannabinoids were shown to be effective, they would be prescribed as of Nov 2018. But the strongest scientific evidence fails to show any meaningful benefit for cannabinoids across a range of conditions. Until the evidence changes, those of us who understand the guidance and who see biased opinion for what it is, will not be in a position to prescribe cannabinoids.

Finally I won’t be the only NHS doctor reading the article who is more than a little insulted at the implication that I would prescribe cannabis if only I was properly educated. We can all access and evaluate the same knowledge base. Those of us who do no private practice and who have no research, professional or commercial ties to cannabinoid companies or clinics, can evaluate the knowledge base without conflicts of interest. Surely that makes us more educated?

The BMJ positions itself as a promoter of good medical practice, free of bias, but in this instance you have let down your editorial guard.

Competing interests: No competing interests

12 September 2019
Ivan L Marples
Consultant in Pain Medicine
Lothian Health Board
Pain Clinic, Leith Community Treatment Centre, Edinburgh