In August 2013, US TV documentary Weed highlighted the case of Charlotte Figi, a six-year-old with Dravet syndrome. This rare, uncontrolled epilepsy caused her to have over 300 seizures a week, as well as severe cognitive and motor delays.
After all other treatments failed, and with the support of her neurologist, Figi’s parents decided to treat her with oil extracted from the cannabis plant, which has been legal for medicinal use in Colorado, where the family live, since 2000. The seizures drastically reduced and after eight months she was 99% seizure free.
In addition, according to her mother, Figi’s severe autism-like behaviours have also gone.
The type of cannabis used to treat her had been cultivated to be extremely low in tetrahydrocannabinol (THC) the psychoactive component of the plant, but high in the molecule cannabidiol (CBD).
The strain, named Charlotte’s Web after Figi, was developed by the Stanley family. This family set up a foundation called Realm of Caring that supplies marijuana to patients, some of whom have relocated to Colorado from states where its use is not permitted, giving rise to the term ‘marijuana refugee’.
Almost as significant as Figi’s story was the public apology of the documentary’s presenter and celebrity doctor Sanjay Gupta. He said this case had made him reassess the evidence on the medical use of marijuana and he apologised for previously opposing its legalisation. He catalogued the many other areas where there are indications of its value: pain relief, inflammatory conditions and even slowing tumour growth.
The media coverage, coupled with campaigning from parents like Figi’s, had a huge impact in the US. Since 2013, a further five states have passed laws, giving a total of 23 states where medical marijuana is now permitted under state laws.
Creating drugs from drugs
In the UK, the legal status of marijuana was revisited in August 2014, when then drugs minister, Norman Baker, called for a review of its medicinal properties, amid concerns that credible people were having to break the law to treat their conditions. The Department of Health stated it had no plans to change the law.
Perhaps one reason for this is because of Salisbury-based GW Pharmaceuticals’ progress in developing medicines from cannabis. In 1998 they were given a licence to work in this area, and in 2011 their first drug Sativex was approved in the UK for treating multiple sclerosis muscle spasms. It is now approved for treating this condition in 23 countries. The mouth spray, containing both THC and CBD extracts is also being tested for cancer pain management.
A second product, Epidiolex, is a pure CBD extract and is in clinical trials for the treatment of Dravet syndrome, the type of epilepsy suffered by Figi. Clinical trials using combinations of THC and CBD extracts for treating inflammatory bowel disease, brain cancer and diabetes are also underway.
The company already has some indication of Epidiolex’s performance. In October 2014, they announced results from an ‘expanded access’ programme whereby a small number of US neurologists were allowed to prescribe the drug. Overall 40% of patients had their seizure frequency at least halved, with 5% becoming altogether seizure free. Whilst not controlled trials, these figures are impressive given that the patients involved had failed to respond to other drugs and GW Pharmaceuticals are hopeful that Epidiolex will be licensed for treating Dravet syndrome by 2017.
Creating pharmaceutical-grade medicines from cannabis is a tricky business, explains Stephen Wright, GW Pharmaceuticals’ R&D director. In an undisclosed location, the company cultivates 200 tonnes of cannabis flowers each year, cloned from a number of cross-bred plants and grown in carefully regulated greenhouses to create a standardised product. Wright explains that because they are growing a controlled substance, ‘we are subject to regular inspections [and] everything we do is indoors, under glass, with security’.
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