11 year old Billy Caldwell, a little boy from Northern Ireland with intractable epilepsy, has caused a stir in the UK popular press. That's because Billy's family doctor, Dr Brendan O'Hare had written a prescription for full spectrum CBD oil and THCa solution.
Dr Hare took this controversial step because the medical cannabis oil Billy had been prescribed by Dr Douglas Nordli, a pediatric epilepsy specialist at Los Angeles Children's Hospital, was about to run out with a very real risk of the child's seizures returning.
Billy - almost seizure free since taking cannabis oil
Last year Billy and his mother Charlotte had become medical marijuana refugees, when they moved to California in search of medical cannabis treatment, and since starting with the cannabis oil supplied by Cannakids, Billy has been almost seizure free.
Billy and his mother eventually returned to their native Northern Ireland, and were allowed to bring Billy's cannabis oil with them. Knowing that the supply was finite, Charlotte decided to campaign for Billy to be prescribed cannabis oil by their doctor, walking a gruelling 150 miles from her home in County Tyrone to the Royal Victoria Hospital in Belfast.
Doctor steps in to help Billy
Their plight was listened to and the hospital agreed to prescribe Billy cannabis oil, which would be supplied by Green Light Medicine in Dublin. But despite the hospital's promises, the date was nearing when Billy's medicine would run out, and nothing yet had been finalised.
This is where Dr O'Hare, Billy's family doctor stepped in. Without official authorization, he issued a prescription for CBD oil, plus THCa. He told local paper Munster Mail: "There are times when the welfare of a patient supercedes other issues. I’m confident in my decision. I could not live with the alternative of Billy having another life-threatening seizure when there is evidence that this medicinal oil is having a positive affect."
Billy - the first person to be prescribed medical cannabis on the NHS?
Before long headlines such as the Daily Mail's 'Boy becomes first person to get cannabis on the NHS' abounded. Others declared this could mark an opening of the floodgates for thousands of UK patients desperate to be legally prescribed medical cannabis.
In an interview with Belfast Live Billy's mother Charlotte herself is quoted as saying: "We have the first prescription for medicinal cannabis in Northern Ireland, in the UK, in Ireland and that means we have set a precedent for everyone else who could benefit from it to ask their GP for the sort of help we have had today."
But what does Billy's case really mean for the rest of the UK? Sadly, quite possibly not quite as much as the papers are saying.
First the myth must be dispelled that this is the first time that medical cannabis has been prescribed in the UK. Since 2010 doctors have been able to issue prescriptions for Sativex, a cannabis medication containing equal amounts of THC and CBD for patients with multiple sclerosis. While the drug is expensive and not all patients find it helpful, it can be prescribed 'off label,' meaning at a doctor's discretion for other non-MS conditions. Although due to the additional responsibility on behalf of the prescribing doctor, this doesn't happen very often.
What does Billy's cannabis oil contain?
A second question remains about what exactly Billy has been prescribed by his doctor. According to the prescription shown in the media, it was for full spectrum CBD oil and THCa solution. CBD oil with less than 0.2% THC is currently legal in the United Kingdom, where it can be bought online and even in some shops on the high street. THCa though is more of a grey area. That's because it is the unheated, acidic precursor of THC, a banned schedule 1 substance. As THCa hasn't been exposed to heat, it is non-psychoactive in nature, and as such is unscheduled by the United Nations' Convention on Psychotropic Substances. However, its close relation to THC makes it open to legal ambiguity and certainly more controversial to prescribe.
Finally, who is paying for Billy's prescription? According to Peter Reynolds from Clear Cannabis Law Reform, this is the most significant implication of Billy's case, because if the National Health Service is paying for a patient to receive CBD oil, this would denote a potentially important development. But even this remains unclear as in the Mid Ulster Mail, Dr O'Hare is quoted as saying the cannabis oil would not be paid for by the NHS.
A rare case of common sense prevailing
So, does Billy's case herald an inevitable shift in UK medical cannabis policy? Right now the jury is out. In reality until cannabis is reclassified as something other than Schedule 1, there will be very little meaningful change. What cannot be denied though is that this is a case of a doctor responding to the clear facts presented to him, i.e. that Billy's condition had responded to medical cannabis in a way that conventional medicine had been unable to achieve, and that if he stopped taking it his life would be in danger.
Dr O'Hare could have turned Charlotte and Billy away, echoing what has happened across the border with Vera Twomey and her daughter Ava, who continues to fight for access to medical cannabis. But no, his humanity has allowed him to see beyond the restraints of antiquated medical protocol. And for that Dr O'Hare, we salute you.