Words by Eleanor Deane, Science and Tech editor
EMMAC Life Sciences Group, Europe’s largest independent cannabis company has become the first in the UK to take complete control of the UK medicinal cannabis supply chain. The co-founder and managing director of EMMAC UK, Ed McDermott, has described this as a ‘ground-breaking moment’ for the medical cannabis industry in the UK. In an announcement to the financial times on 16 October 2020, EMMAC stated that this control of a vertically integrated supply chain will make medical cannabis more affordable.
Medical cannabis consists of products derived from the cannabis plant, including THC and CBD. THC is the component that causes the ‘high’, whereas CBD is not intoxicating at typical doses. Cannabis extract and cannabidiol are both currently used medically in rare specialist cases, which was legalised on 1 November 2018. Cannabis extract is licensed for use by specialists to control certain symptoms in multiple sclerosis. A large analysis of studies found the effectiveness in this area to be limited and use is not recommended due to poor cost-effectiveness. Cannabidiol can be prescribed by specialists in the treatment of two rare forms of childhood epilepsy.
Beyond these two applications, regulatory challenges have acted as a barrier to the collation of evidence on the efficacy and safety of medicinal cannabis. As a result, there is a lack of placebo-controlled randomised controlled trials, which is the current gold-standard of evidence. However, in an article published in the British Medical Journal (BMJ) on 21 September, Professor David Nutt and colleagues highlight that the European Medicines Agency licence many medications without this level of evidence. They suggest that a potential reason for resistance is concerns related to the risks of recreational cannabis use, such as the link with schizophrenia, which they argue have largely been debunked in relation to medicinal use.
Whilst there have been some changes in legislation, importantly, the issue of cost has remained an additional barrier. In the UK, treatment with medicinal cannabis can cost upwards of £1000 per month. In many cases, patients end up seeking private healthcare and paying for treatment. In a feature from the BMJ in September 2019, UK supplier Grow Biotech stated that of the 80 prescriptions it had fulfilled, all were for patients seeking private healthcare.
These high costs may partly be due to different companies being involved at each step in the supply chain, meaning costs mount progressively at each stage in the chain. The UK branch of EMMAC is now the first company in the UK to be involved at every stage in the supply chain, removing additional expenses. EMMAC UK will control each stage, from cultivating and processing to manufacture and distribution.
As reported on the BBC, one patient recounts he was paying £300 a month or buying products on the black market for £70 a week and now is paying £40 per month for treatment through a private clinic due to the new changes from EMMAC. A 2020 report from the centre for medicinal cannabis estimates that the vast majority of the estimated 1.4 million medicinal cannabis users in the UK buy cannabis on the black market. For patients, this may lead to problems with illegality and unknown quality. If medicinal cannabis were to be cheaper than cannabis sourced on the black market it would result in positive consequences for these patients.
In their BMJ article published in September, Professor David Nutt and colleagues highlighted a need to conduct a full health economic analysis in order to clarify cost implications of prescriptions as quality cost-saving analyses are currently lacking. It is still unclear how these recent changes in the supply chain might impact these economic evaluations of cost-effectiveness.