The next item is the Member debate under Standing Order 11.21, and I call on Mark Isherwood to move the motion.

Motion NDM6565 Mark Isherwood, Leanne Wood, Mike Hedges, Rhun ap Iorwerth

To propose that the National Assembly for Wales:

1. Recognises that there is clinical evidence of the effectiveness of cannabis for medicinal purposes.

2. Recognises that, whilst Wales is the only nation in the UK where the cannabinoid symptom management drug Sativex is available on the NHS, it is only licensed for the treatment of spasticity and only then available to a small group of people living with Multiple Sclerosis (MS) who meet the criteria.

3. Believes that the Welsh Government should ask the UK Government to reschedule cannabis for medicinal purposes; and, in preparation for this outcome, the Welsh Government should map out within the Welsh NHS how a system whereby cannabis for medicinal purposes could be made available via a prescription to those who could benefit.

4. Notes that:

a) many people living with conditions such as Multiple Sclerosis, Dystonia, Epilepsy and Cancer in Wales use illegally obtained cannabis for medicinal purposes but by doing so risk prosecution and are also being exposed to other drugs; 

b) the All Party Parliamentary Group (APPG) for Drug Policy Reform in the House of Commons emphatically called on the UK Government to legalise medical cannabis based on the results of their 7 month inquiry into the issue and on the findings of an independent review of global evidence led by Professor Michael P. Barnes;

c) there a growing number of countries which regulate the medical use of cannabis and cannabis derivatives, such as Canada, the Netherlands, Israel and over 20 States in the US, who regulate herbal cannabis for medical use;

d) a number of countries, including Germany and Switzerland, enable patients to import cannabis for medical use from the Netherlands;

e) the MS Society UK has changed its policy position to call on the UK Government and health bodies to ‘develop a system that legalises cannabis for medicinal use’ in light of positive evidence of the use of cannabis in treating pain and spasticity;

f) Newport West MP Paul Flynn’s 10 minute rule bill on the legalisation of cannabis for medicinal use was put through unopposed to the next reading on 23rd February 2018 on 10 October.

Motion moved.

Diolch, Llywydd. Today's debate follows a meeting of the cross-party group on neurological conditions on medicinal cannabis that took place in October 2017, attended by people from across Wales living with a range of medical conditions—many of whom are in the public gallery today—who find a benefit from using cannabis for medicinal purposes, but by doing so run the risk of prosecution. As both a north Wales Assembly Member and chair of the cross-party group on neurological conditions, I've been working with MS Society Cymru on this issue for some time. The motion recognises that whilst it may not be currently in the gift of the Welsh Government to legalise cannabis for medicinal purposes, it is asking the Welsh Government to ask the UK Government to reschedule cannabis from Schedule 1 to Schedule 2 so that it may be prescribed and legally supplied in recognition of the medicinal value of the drug. 

In July 2014, the All Wales Medicines Strategy Group recommended Sativex, a cannabis-based drug, for the treatment of spasticity, and only then available to a small group of people living with multiple sclerosis who meet the criteria. The Welsh Government agreed to endorse this. Wales was the first UK nation to approve Sativex. However, MS Cymru expressed concern in March last year that many people were struggling to obtain it because the infrastructure didn't exist. It's only in the last few months that all local health boards in Wales are able to prescribe Sativex to those people living with MS who are deemed eligible. The MS Society UK changed its policy position to call on the UK Government and health bodies to develop a system that legalises cannabis for medicinal use, in light of positive evidence of the use of cannabis in treating both spasticity and pain. The society estimates that around 10,000 people with MS in the UK could benefit from this—not everybody, but a huge number of people. As the MS Society Cymru states, symptoms associated with MS can be relentless and exhausting and make it impossible to manage daily life. The conventional daily drug regime for those experiencing these symptoms can include morphine, codeine, paracetamol, pregabalin and diazepam.

The clinical and anecdotal evidence of the effectiveness of cannabis for medicinal use is compelling. People living with conditions such as multiple sclerosis, dystonia, epilepsy, arthritis, cerebral palsy and cancer who use cannabis to alleviate the symptoms associated with their conditions cannot wait for a time when Wales may have the legislative competence to legalise cannabis for medicinal use. They should be able to make the decision without fear of prosecution. Accessing a reputable supply of cannabis is a real issue for many. Some feel forced to utilise street dealers. Some are concerned that, by using cannabis, they'll be putting the people close to them at risk of prosecution and exposure to other drugs. In September 2016, the UK all-party parliamentary group for drug policy reform emphatically called on the UK Government to legalise medicinal cannabis based on the results of their seven-month inquiry into the issue, and on the findings of an independent review of global evidence, led by Professor Michael Barnes, which ran alongside the inquiry. That report heard that people are suffering unnecessarily and that some in great pain are travelling abroad to find the cannabis they need to ease their symptoms. And it concluded that all this could change by moving cannabis from Schedule 1 to Schedule 2 for medical purposes. Such a change would also free up research and lead to new medicines for chronic pain and disease. 

Professor Michael Barnes, who is a UK neurologist and rehabilitation consultant, has highlighted dozens of peer-reviewed research papers that have proved the efficacy of medical cannabis. He said such drugs have alleviated pain in all its manifestations, treated muscle spasms, anxiety and nausea and vomiting in patients undergoing chemotherapy. He also said there was evidence that medicinal cannabis was successful in helping people with epilepsy and sleep disorders, and described the side effects associated with using the drug in a medicinal setting as minimal. He added that thousands of people with chronic conditions can benefit from this drug that has been around for centuries. 

A recent study from Tel Aviv in Israel found that medical cannabis significantly improved the condition of children suffering from cerebral palsy. According to their interim findings, treatment with cannabis oil reduced the disorder's symptoms and improved the children's motor skills. It also improved the children's sleep quality, bowel movements and general mood. 

Arthritis Care Wales and Arthritis Research UK state there is an urgent need for better pain relief to help the millions of people who live with the daily agony caused by arthritis, and that previous research has suggested that drugs that targeted cannabinoid receptors could help to relieve pain and inflammation in the joints. When I attended the Gout: No Laughing Matter Assembly reception last November, I learned of arthritis sufferers who use cannabis to help manage the pain caused by their condition. Last month, WalesOnline reported a grandmother from Cwmbran diagnosed with MS in 2014, who stated that after being prescribed a number of medications with bad side effects, she now relies on cannabis to relieve her symptoms. However, highlighting the dangers of buying cannabis, she recalled that a close friend of hers who was suffering with MS was robbed at knifepoint when attempting to buy some cannabis to treat her condition. 

I've recently been contacted by a number of constituents regarding this debate. One said:

'I have MS and believe many people who have long-term illnesses and live with pain could benefit from the use of cannabis.'

Another said:

'I live outside Wrexham and have had MS for 18 years now. I've recently gained access to Sativex, which is benefiting me greatly. However, this is not prescribed for pain, and I understand the benefits of using cannabis really helps with this and other symptoms too.'

Earlier, in this building, I met somebody who's travelled from north Wales who I understand has MS who doesn't access cannabis because it's illegal, but wants the legal right to choose to do so to see whether it does give him pain relief. He's here today. He wants to hear some positive news from us. 

As MS Cymru have told me, many people have said that they were not using cannabis to try to manage the symptoms of their conditions because they simply don't know where to get it, or how much to take if they did.

There are a growing number of countries that regulate the medical use of cannabis and cannabis derivatives because of the strength of the evidence—Canada, the Netherlands, Israel, and 29 of the states in the United States of America regulate herbal cannabis for medical use. A number of others, including Germany and Switzerland, enable patients to import cannabis for medical use from the Netherlands. These are countries that do not legislate in such matters without an evidence base. Ireland's Cannabis for Medicinal Use Regulation Bill 2016 was passed in the Dáil in late 2016 and is currently at Committee Stage. In the meantime, licences are being used on a case-by-case basis by the Irish health Minister. 

Our motion also calls on the Welsh Government to map out a system within the Welsh NHS whereby cannabis for medicinal purposes could be made available via prescription to those who could benefit. One of the positions that is used against making cannabis available for medicinal use is that we would potentially see patients getting their prescriptions for cannabis and selling it on the streets. However, as the director of MS Society Cymru has stated:

'Since my time at the MS Society, I have never known of anyone living with MS who collects their Oramorph or any other drug for that matter then heads off to the nearest street corner to sell it!'

I suspect the same applies to people with other conditions in a similar circumstance.

In October last year, Labour's Newport West MP, Paul Flynn, presented a 10-minute rule Bill on the legalisation of cannabis for medicinal use in Westminster. The Bill was put through unopposed to the next reading on 23 February 2018. I repeat: the Bill was put through unopposed. As he stated,

'The tide of world opinion is moving in the direction of legalising cannabis. Some 29 states in America—the majority—have already legalised medical cannabis without any problems arising. There are six or seven states in Europe where it is possible to use cannabis medicinally.'

He added:

'If we legalise drugs, we reduce side effects by taking the market out of the hands of the criminals and the scammers, and putting those drugs in a legal market that can be run by doctors using medical priorities. These are the lessons from all the states in America that have taken this step.'

He continued:

'It is time for us to lead public opinion rather than following it. It would be an act of compassion and courage for us to pass this Bill and make the very minor change it proposes: moving cannabis from schedule 1 to schedule 2.'

After all, because it is appreciated that there are people with chronic pain and debilitating illnesses who seek to alleviate their symptoms illicitly by using cannabis, the majority of whom would far rather obtain legally prescribed cannabinoid medication than be forced to smoke or access illegal substances, the Sentencing Council's guidelines on drug offences already identify such circumstances as a potential mitigating factor. What a ridiculous state of affairs. Instead, Wales should have a system whereby cannabis for medicinal purposes can be made available via prescription to those who could benefit. So let us make this happen now.

First of all, can I thank Mark Isherwood for his enthusiasm in bringing this debate forward and for what he said up to now on it? There's nothing he said that I disagree with. The good news is that I'm not going to replicate any of it.

Firstly, can I say what this debate is not about? It's not about legalising cannabis for recreational use. It is not a legal excuse that someone caught with cannabis can use, saying, 'Oh, I've only got it for medicinal reasons.' It's not about people being able to import it and say, 'I've only brought it in for medicinal reasons.' It's not about: 'I'm going to take some cannabis; I think it might help me.' It's not about self-medication with cannabis. It's certainly not a back door method to legalising cannabis. It's about trusting our medical practitioners to prescribe the drug if they think it will benefit the patient.

To me, the key point, and one I asked Mark Isherwood to insert prior to signing up to the resolution, is:

'map out within the Welsh NHS how a system whereby cannabis for medicinal purposes could be made available via a prescription to those who could benefit.'

To me, the key words are 'via a prescription'. It's got to be via prescription, meaning a person medically qualified who is able to write a prescription can prescribe it. No-one else can prescribe it or tell somebody down the road, 'I think you'd benefit from a bit of cannabis. Just say that and you can get away with it.' It's about ensuring we trust our medical practitioners.

If you don't, and you don't have a prescription for it and you're using it, you'll be treated by the courts exactly as you are now. At Westminster, the all-party parliamentary group for drug policy reform, as Mark Isherwood just said, emphatically called on the UK Government to legalise medical cannabis based on the results of their seven-month inquiry. The MS Society, which was against it, has changed its policy position to call on the UK Government and health bodies to develop a system that legalises cannabis for medicinal use in light of the positive evidence of the use of cannabis in treating pain and spasticity. This is something some of my constituents and some people I know have been making a case for: it has health benefits. I think that's really the key. People are taking it for health benefit, not for some recreational purpose. 

Where the cannabinoid symptom-management drug, Sativex, is available on the NHS—and the Welsh Government have gone that far in making it available—it is only licensed for the treatment of spasticity to a small number of people living with multiple sclerosis. I am asking that cannabinoid drugs should be available where medical practitioners believe they can help. Would this be setting a bad precedent? I think that's one of the arguments that have been used against it. Well, let me ask you what the following drugs have got in common, apart from being available to patients: morphine, thebaine, oxycodone, hydrocodone, buprenorphine, oxymorphone and hydromorphone. All are either natural derivatives or synthetic derivatives of opium, and they are available on prescription.

Now, there are those of us who think that opium-based drugs are far more serious and dangerous than cannabis. They are available and people have morphine—many people have morphine towards the end of their lives in order to stop the pain. This is asking for the same availability of cannabinoid drugs to be available for people suffering from MS to help stop their pain. Let the medical practitioners, not politicians, decide if patients would benefit. 

Finally, I do not support legalising cannabis for non-medical use, and before anybody asks, no, I have never smoked cannabis or taken it in any form. But I urge Members to trust medical practitioners to prescribe cannabinoid drugs, as they do opiates, when the patients can benefit. Let the medical practitioners be the ones making the decision, not us making it out of our prejudices.

I'm pleased to be able to contribute to today's debate and to sponsor it alongside colleagues from several parties in this Chamber. It follows effective evidence-based campaigning by the MS Society UK and others, and valuable discussions at the cross-party group on neurological conditions. At a meeting of that group last October, I encouraged patients and politicians to take forward a campaign on this, and I'm happy to offer my continued support to that campaign today.

The classification of drugs is something that is mostly decided at the UK level. Now, I and us on these benches want that situation to change; we want to be able to decide these matters for ourselves here in Wales. But in the meantime, I've argued that Wales should adopt a position on this. We've had Sativex licensed for usage here, but access is difficult and limited. We have a wider situation whereby some people who are living with MS and other conditions are forced to use cannabis illegally to help with their symptoms. I've heard testimonies from people having to buy cannabis in a way that is still technically illegal, and a situation where old-aged pensioners have had to find dealers who can grow and sell cannabis, when morphine, as others have said—and morphine is, effectively, heroin—is given on prescription. Now, that can't be right, and it shows how counter-productive current drug policy is in this country.

I was disappointed to see the Welsh Government in the media today using prohibition as an excuse not to regulate cannabis. I'll just quote the Welsh Government, who said, through a spokesperson, and I quote:

'Using an illegal raw drug of unknown quality is not how we want to provide medicines.'

Llywydd, the whole point of medicinal cannabis is that it is no longer an illegal raw drug, it's no longer of unknown quality, because it can be sourced properly and regulated, and the different strains and their different benefits can be properly understood. 

Retaining prohibition will not reduce cannabis use. It just prevents safe, regulated medicinal use and pushes law-abiding people towards an illegal marketplace. That's why a clear step forward is to decriminalise cannabis for medicinal use, and the motion today sets out how Wales could advocate such a change and also prepare for it to happen.

The wider debate about whether drugs should be prohibited and accessed illegally or whether they should be controlled and regulated so that they can be used safely is still one that we must have. But we've got examples in this motion of countries and territories that have allowed this change for medicinal use of cannabis, and those countries have been listed, but Canada and the Netherlands come to mind. 

Now, I'm pleased to see reference to the review by Professor Michael P. Barnes, originating from the all-party group at Westminster, and it's important that the evidence as to how cannabis helps manage symptoms can be solidified and publicised. After a seven-month inquiry, the Barnes review found evidence, and I quote:

'Overall, there is good evidence for the use of cannabis in many important conditions that effect many thousands of disabled people.' 

I hope today's debate leads to an outcome where the Welsh Government now can adopt a formal position on this. The Welsh Government should make the case to the UK Government for cannabis to be available for medicinal use. It should then map out how prescriptions could be produced for those in need and, failing that, if the Government doesn't want to rock the boat or be bold, why not offer to meet Professor Barnes and hear a summary of that evidence? By building the case and sending a message that Welsh patients could benefit from these treatments, we can help win the argument at a UK level where decisions on decriminalisation are still made.

This Assembly is here to be radical, to take steps that help Welsh citizens to make a practical, real difference to people's lives. Sometimes, what can seem very radical is actually only common sense. Diolch yn fawr.

I'd like to thank Mark, Leanne, Mike and Rhun for bringing forward this debate today. Cannabis has many medicinal benefits. It can be used to control pain, treat spasticity, help with the side effects of chemotherapy, and new studies show it can help control epileptic seizures in children. We are only just beginning, though, to understand the possible benefits that cannabis can deliver, and I welcome wider research into its use for medicinal purposes.

I cannot, however, support the reclassification of cannabis, in the same way I would not support the reclassification of opium or heroin, which may also have medicinal purposes. Unfortunately, smoking cannabis has many harms associated with it. The British Lung Foundation identified cannabis smoke as a carcinogen and also found that awareness of the danger was very low, with 40 per cent of under-35s thinking that cannabis, when smoked, was not harmful. Studies have found that THC, the principal psychoactive substance within the cannabis plant, can cause cognitive defects, particularly if taken long term—

Will you take an intervention on this, please?

Yes, certainly.

From what I gather, we're talking about the drug Sativex, which I fully endorse. I'll stand with you on this one. When you talk about—this is an unknown intervention from me; I'm new, okay. When you talk about smoking cannabis, it isn't just smoking cannabis as you would smoke a cigarette.

You're taking an amount of time.

I'm really, really sorry. There are other drugs out there that are cannabis based, like cannabis oil and all those cannabinoids and—.

I do understand.

Thank you so much. It's not just about smoking.

It's all right; you're welcome.

Studies have found that THC, the principal psychoactive substance within the cannabis plant, can cause cognitive defects, particularly if taken long term. Recent medical evidence strongly suggests that the long-term use of cannabis by people who begin use at an early age—they display a higher tendency towards mental health problems and other physical and developmental disorders. According to a 2014 Northwestern Medicine study, when cannabis use begins in the teen years, it can have a significant impact on brain development, including decreased brain activity, fewer neural fibres in certain areas and a smaller than average hippocampus, which controls learning and memory functions.

In my years working in the prison service, I witnessed first-hand the harms associated with smoking cannabis long term. Many of the young people suffered from paranoia, anxiety, memory problems and other such problems. We therefore need further research into the long-term use of cannabis, particularly its effects on young people, before we can say it's safe to reclassify it for medical use.

The MS Society state that there is currently insufficient,

'evidence to suggest that smoking cannabis can treat spasticity or pain in MS and smoking can negatively impact on an individual’s MS.'

Therefore, we need to focus on extracting the benefits from the cannabis plant, whilst, at the same time, mitigating the potential harms. The main problem with cannabis is the complexity of the active ingredients, the huge variation that exists in the levels of compounds between the species of plants, the various cultivars, and even in plant to plant. While a particular strain of plant, or cultivar, could be developed to increase the medical benefits and limit the psychoactive effects, there is no guarantee that the mix of active ingredients are the same from one crop to the next. There is no disputing—. [Interruption.] Not another one, sorry. I'm out of time.

There is no disputing the huge benefits that the various cannabinoids can have in treating a number of conditions. I believe we have to work at isolating those compounds. In the UK, we license Sativex, an extract of cannabis, to treat MS symptoms. In the US, too, additional cannabinoids have been created to treat the side effects of chemotherapy. I hope to see this work accelerated.

Given the possible harms and the limited evidence base about the efficacy of smoking cannabis for medical purposes, I cannot support the legalisation of medical cannabis at this stage. I will, therefore, be abstaining on the motion today, although other Members in my party will have a free vote. I look forward to new research into the medical use of cannabis, and if it can be shown that the benefits vastly outweigh potential harms, I would be happy to support the rescheduling of the drug at that stage. Diolch yn fawr.

It was only last week I raised this question with the Minister, and I'm very pleased, within a week we are debating on this issue. Over 100,000 people in the United Kingdom suffer from multiple sclerosis. In January 2016, the number of MS sufferers in Wales stood at 4,260, and every year, another 200 people are diagnosed with the condition. MS is unpredictable and different for everyone. It is often painful and exhausting. Quite simply, it can make it impossible to manage daily life. There are treatments available, but they do not work for everyone.

We know that, in some cases, cannabis compounds could help in relieving pain. In the United Kingdom, MS is the only condition that has a licensed treatment derived from cannabis. Sativex is currently available in Wales on the NHS, but not in other parts of the United Kingdom. The benefit of Sativex was brought home to me recently in a message I received from a constituent. Presiding Officer, I'll read that little note from my constituent. He said, 'I have had multiple sclerosis since 2003. I suffer from spasticity, muscular spasms and pain, for which I take morphine and liquid morphine daily. More importantly, I take Sativex, which I have been taking since I was bed bound for six months a few years ago. I cannot explain how much this drug helped me, as I'm trying my best not to be in my wheelchair full time. It helps with my spasticity and muscle spasms, and I cannot explain how much worse it was before I started on the drug. Before, I also tried normal cannabis and risked prosecution, and I can compare both and, obviously, it is not as strong as the Sativex. I, myself, am lucky as I meet the criteria. Lots of other MS sufferers do not have to risk prosecution, which I, myself, have, when I have been in so much pain and did not know what else to do. If you are in extreme pain for long enough, I think it breaks the strongest person after a few years. So, please support this Bill as you do not know the dramatic difference you can make to MS sufferers in Wales.' His message ends.

I think it says everything, Presiding Officer, and this, I believe, is a crucial point. Law-abiding members of the public are being driven to break the law to relieve their pain in this civilised country, or this civilised world. It's very, very, very unethical. It is time to realise cannabis for medical purposes. Currently, cannabis can only be obtained from illegal gangs who also push hard drugs. So, we are driving soft-drug users into the arms of hard-drug pushers.

Many other countries, like Germany and Canada—like my colleagues have already mentioned—have made cannabis available for medical use. Only in the last couple of weeks, even California in the United States of America has legalised on medical grounds. Ireland is also considering following suite. Wales must take the lead on this, Presiding Officer. It is time to relieve the pain and suffering experienced by people with MS in Wales.

I, only this week, put a survey on my social media internet—on Twitter. This afternoon, 14:30, 70 per cent of my followers agreed to have cannabis legalised in Wales. Forget London and everybody, we made this law here, and 70 per cent is a good number in south-east Wales. I'm pretty sure if you all go for a survey of the whole country, of Wales, I'm pretty sure you'll find that the majority of people will support cannabis to be used on medical grounds and get pain relief for these people who are getting the illegal drug, and this is totally unacceptable and unethical. We should help them right, left and centre. Thank you.

I'm very pleased to be supporting this debate today. To me, it's a simple matter—a very, very simple matter. When people are suffering an illness that has symptoms that most of us don't have an idea of their seriousness, nor how they bring everyday life to a stop; where living with the condition is a real pain that paralyses someone, or makes them feel that life is not worth living; where sleep doesn't exist, night after night; I think that everything possible should be done to alleviate that suffering.

What we're discussing this afternoon is the right to use cannabis as a tool to alleviate pain or suffering. Cannabis, of course, is a word that is controversial. Debates and arguments on decriminalising cannabis or legalising cannabis for recreational use have existed for many decades. There are strong viewpoints on both sides of that argument. But, today, may I appeal to people to leave their views on that debate to one side? We're not talking about that today. We're talking about a drug in the medical sense, and no other sense at all. The fact that that drug is used in a different context by some people should not be a barrier to looking at the values of cannabis as a medical drug.

The Conservative Member for Clwyd West—I'm pleased to see him in the Chamber—has confused both issues in the past. I read an article where he was quoted as saying:

'Cannabis, whether used for medicinal or recreational purposes, is a dangerous substance and would have catastrophic consequences to health and society if it was ever legalised.'

You cannot, though, just slip out the phrase

'whether for medicinal or recreational purposes' as if the two are one and the same, because they're not, and that is the appeal I make today and, of course, I'll welcome an intervention.

I'm grateful to you for taking the intervention. I wrote that article because I was concerned that there was a growing number of people who were taking an interest in the use of raw cannabis for medicinal purposes. I object to the use of raw cannabis for medicinal purposes. I do not, however, object to the use of cannabis-derived drugs that are effective clinically and can reduce the sorts of symptoms that you and others in the Chamber this afternoon have been describing. We have a drug that is available in Wales, which I campaigned to be made available in Wales, and if other drugs pass through the regulatory hoops because they are found to be effective in relieving suffering, and they are derived from cannabis, then I'd have no problem with those either. But what I object to is an increased availability of raw cannabis, which I do believe could and would be abused, and be dangerous in our society in Wales.

I welcome that intervention, but I would point out that what we would be talking about here is possibly regulated raw cannabis, which would be much safer, of course, and would be prescribable. That is the whole point of what we're talking about. I will also address a point that was made in an intervention and also from the UKIP Member for South Wales West, who talked about smoking cannabis. Who's talking about smoking cannabis here? I think it's very important that we are able to draw that distinction. But it is irrelevant to today's debate whether Darren Millar or anybody else is right or wrong on the risks of cannabis as a recreational drug, because we're not talking about that; I hope I've made that clear. And, in fact, there are plenty, of course, of examples of the abuse of prescription drugs. You don't, as a result of the abuse of prescription drugs, ban those prescription drugs that have proven beneficial effects when used in a correct way. What you try to do is tighten control of those drugs—absolutely. Cannabis, it seems to me, is treated in the opposite way. Used widely recreationally, with beneficial effects medicinally, but not allowed to be used.

The evidence is clear, I think, or certainly I have been convinced. In 2016, as we heard, the results of seven months of research by a cross-party group in Westminster were published. That inquiry, in turn, was based on a world-wide review of evidence, and the very clear recommendation was that cannabis should be legalised for medical use.

It is important, of course, that we draw up legislation or come to a view, as we wish to do today, based on evidence, and here we have the evidence, I think. The MS Society looked at the evidence very carefully before deciding to change its policy on this, and now they are enthusiastic supporters and enthusiastic campaigners on this issue. Why? Because they know about the advantages. They deal on a daily basis with people who are looking for ways to alleviate the effects of a cruel disease. Let us as an Assembly look objectively at the evidence and give our support to those individuals who would benefit from this sensible change.

I call on the Cabinet Secretary for Health and Social Services, Vaughan Gething.

Thank you, Presiding Officer, and I'd like to thank Members for their contributions today, and the consideration that they've given to the concept of providing herbal cannabis to patients for medicinal use. I recognise the very genuine and cross-party interest in this subject, and a very sensible debate, I think, it's been, about—. But, before I go into the heart of the Government response, I want to recognise that there's more than one purpose to having these Member debates. There's something about saying you definitely want the Government to do something in the here and the now, and some people may want that to happen absolutely, and others may want to make sure there continues to be a public debate about the use of cannabis for medicinal purposes and how that can be advanced. But, for myself and from a Government point of view, the motion provides not just food for thought, but, in practical terms, for me it raises more questions than answers. And I do, of course, accept that there is some evidence that cannabis or its derivatives can have a role to play in managing chronic pain, anxiety, spasticity, and nausea and vomiting in the context of chemotherapy. And historically, of course, a tincture of cannabis was used for pain relief alongside laudanum and opium. However, we are now far more aware of the damaging side effects of poorly understood, poor-quality drugs, and prefer to use safe and regulated medicines. And we want people to have access to licensed, effective medicines to alleviate these conditions rather than people resorting to what are currently illegal drugs of unknown provenance, potency or purity.

I think it's fair to comment on some of the confusion about the purpose in what we're being asked today, because, in different contributions by proponents and supporters of the motion, we've heard the difference between, say, herbal cannabis and making that available for medicinal use, or the use of cannabis derivatives, or, as has been regularly referred to, cannabinoid drugs. I want to clarify: I don't think, from a Government point of view, this is really a debate about decriminalisation. There are different issues about decriminalising cannabis. I think this is really about should you make it available for a specific purpose, and, if so, in what form. So, it isn't about a prohibition on cannabis derivatives in licensed medicine.

But I'm pleased that, in the course of the motion, Members did recognise that this Government is the only administration in the UK that has recommended using Sativex to treat the spasticity symptoms of multiple sclerosis, such as spasms and cramps. It maybe helpful to remind Members how and why we did so: because the manufacturer took considerable time, money and effort to develop Sativex, the first cannabis-derived medicine in the world. The company had to produce a safe, effective medicine that met modern standards, and therefore followed exactly the same rigorous procedure required for the development of every new medicine for use in the UK. That included identifying which of the 60 cannabinoids and other chemicals present in cannabis could act to reduce pain. At that point, it's worth mentioning that the pharmacological effects of many of these are still unknown. Having identified them, the development stages then involved establishing the most effective combination of these chemicals and early testing for toxicity before proceeding to a clinical trial stage. The clinical trial phases are, of necessity, tightly regulated to protect the volunteer test subjects and the subsequent potential patient population. It's worth noting that it's been estimated that only four out of every 100 medicines developed by pharmaceutical companies ever make it to market.

In the UK, the Medicines and Healthcare products Regulatory Agency, the MHRA, they licensed Sativex for use in the UK in July 2010. That is only one part of making it available on the NHS, because they only authorise a licence or a marketing authorisation when satisfied that the medicine is safe and treats the targeted condition. Then the National Institute for Health and Care Excellence or the All Wales Medicines Strategy Group appraise new medicines by comparing their clinical and cost-effectiveness with existing treatments already on the market. Now, NICE does not recommend Sativex for treating spasticity in MS on cost-effectiveness grounds—so, not efficacy, but on cost-effectiveness. As a result, it's not available routinely for NHS patients in England, but the Welsh Government asked the AWMSG to undertake an appraisal of Sativex, and they recommended it to us in August 2014. My predecessor then made sure that it was available in Wales from that point, where clinically appropriate. I know there have been challenges about getting Sativex properly available to all people who could and should benefit, but that in itself has nothing to do with the fact that it is a cannabis derivative. There's a broader challenge there that we're trying to address within Government about making sure that the new medicines that are recommended and are available are then made properly available to all people as clinically appropriate.

This underpins our approach, not just here today in this one instance, but together with the appraisal process, and indeed the review we had on the individual patient funding request process as well, that we want to have and we will continue to take an evidence-based approach to determining which medicines could and should be made available on the NHS here in Wales.

Thanks for giving way. I also welcome the fact that the Welsh Government did make Sativex available for the treatment of medical conditions. Isn't key to this motion, though, the problem that it is not available to all those people who need it, perhaps because there are supply issues, cost issues—whatever that might be—and people are currently being criminalised because they are having to use cannabis in the raw form, as it's been referred to, because it's not available? Those people should not be criminalised, because they have an illness and they are seeking treatment that is not available to them through the NHS currently.

I don't think that's a fair characterisation of the way in which medicines are made available in the national health service. There's a challenge here about saying, 'There's an unmet need', and 'How do we get an effective, licensed, safe product available on the national health service to do that?', and simply saying, 'The answer is to make cannabis available medicinally'. I'll come on to some of the challenges about that, but Sativex became available because it fulfilled all of those criteria: the safety and efficacy tests of licensing, and then, secondly, the medicine passed the rigorous appraisal process—

Will you take an intervention?

—and that is the most scientific and impartial method to ensure that patients receive safe and effective medicines.

Just very briefly—and thank you for taking the intervention—wouldn't removing the barrier of legality help ease the way towards seeking methods of using cannabis in a medicinal way?

I don't think that's borne out, actually. I'll try and go through why in the remaining time available. Because what the motion advocates is the use of herbal cannabis and circumventing our long-established and respected regulatory and appraisal processes. Those processes are in place to safeguard patients and ensure public money is being spent on proven clinical and cost-effective treatments. Without an evidence base, without clarity on purity, dosage and strength and the conditions for treatment, we would also place prescribers in an untenable position. Because you have to understand, if you're not going to have a cannabis-derivative drug that, at present, you can have available—. The fact that cannabis itself is not a lawful recreational drug doesn't make any difference to that. It's about the ability to isolate the cannabinoids and then to test them in a rigorous, safe process and make sure they are cost-effective as well. That's the only bar to getting cannabinoids available in a drug form to be available within the national health service. If you then make a raw form of the drug available, or a herbal form, then you can't know the potency of that. You can't know what condition you'd prescribe that for and the strength for that particular condition as well. It's a practical challenge, as opposed to a principled objection to medicinal cannabis, and that's the point. It's about how we take a genuine evidence-led approach to making medicines available on the health service. [Interruption.] I don't know if the Llywydd will allow me even further latitude on time to take a further intervention. 

Yes. Please do.

Thank you. I'm very grateful to you for taking the intervention. I have to say, I find myself in the unusual position of agreeing with almost every word that you've said. One thing I think that would be very, very important would be further research into the benefits of cannabis and some of the medicinal purposes for which it can be used. I wonder, Minister, whether there's any work that you could do, perhaps with the AWMSG and with pharmaceutical companies, to help to isolate some of these key chemicals in the cannabis plant that might be beneficial to people's health in alleviating symptoms. Is that something that you might be able to do as a Welsh Government?

Well, I think the next parts in my contribution may help with that. I said earlier that there are 60 different cannabinoids that the manufacturers of Sativex had to identify, then go through those that would help with particular conditions. The manufacturer of Sativex is currently developing three new cannabis-based medicines to help treat epilepsy, schizophrenia and autism spectrum conditions. A further 18 cannabis-based medicines are in development by other manufacturers to treat a range of conditions. So, this is an area that is rich in research and the potential for cannabis derivatives to be made available in a safe, licensed and effective form. 

Now, the report produced by the all-party parliamentary group, or this motion, they don't indicate the costs associated with introducing a regulatory system for herbal cannabis as a medicinal product, or indeed the costs of establishing and managing a new regulatory body to oversee production, procurement and distribution, and they're based on the costs of monitoring its use, including reporting and investing adverse incidents. There's a challenge here about how we choose to direct the national health service or press upon it to spend its resources. At this time in particular, I can't say this would be this would be a priority for me as a health Minister. But I am interested in the way in which we take advantage, in exactly the same way that any other new medicine comes into the market.

I have to say, just dealing with the point made about drugs legislation in other countries, it's true that other countries have taken a different view. But other countries take different views on a range of subjects as well. Just because states in the United States of America do this, it doesn't say that we must follow. We have a range of differences that I celebrate between ourselves and the United States, as well as key similarities that I would also celebrate too. And I don't think this is a campaign issue to replace our evidence-led approach to new medicines. Sadly, the motion, if implemented, would undermine our national evidence-based approach, and I want to ensure that the health service continues to provide safe and effective treatment. On the basis of the reasons I've set out, the Government will not support the motion, and we will be abstaining. 

I call on Mark Isherwood to reply to the debate.

Can I thank everybody who's contributed? Mike Hedges came straight in with the key point: this is not about legalising cannabis for recreational use. It's about ensuring that we trust our medical practitioners to provide legal prescriptions of cannabinoid drugs when patients can benefit. As Leanne Wood said, following effective evidence-based campaigns by MS Cymru and others, plus the cross-party group on neurological conditions, she has reached a principled position, that people are forced to use cannabis illegally to manage their symptoms, yet morphine—effectively heroin—is given on prescription. She said that this is about stopping people having to access an illegal raw drug—stopping people having to access an illegal raw drug. The wider debate about drugs is a different debate, because this is a health debate.

Caroline Jones said that cannabis has many medical benefits, but doesn't support the reclassification. She said that THC in cannabis can cause cognitive defects. Well, the marijuana plant is comprised of over 100 chemicals, or cannabinoids, with each having different physical effects. The two main chemicals are THC, which we referred to, the element that produces the high, and CBD, which does not produce any psychoactive effects. The particular point about medical cannabis is that it has a high CBD content, not a high THC content.

Mohammad Asghar said that over 100,000 people in the UK have MS, including 4,260 in Wales. He talked about the benefits of Sativex for spasticity, but also noted that lots of MS sufferers have to risk prosecution to manage their pain, and Wales must take the lead on this. Rhun ap Iorwerth said it is a simple matter: everything possible should be done to alleviate suffering. Cannabis use for medical and recreational purposes is not the same, and there are plenty of examples of existing prescription drugs being abused, but we don’t ban those.

The Cabinet Secretary’s speech was largely a response, I feel, to what I didn’t say, rather than an evidence-based response to what I did. He said that just because the United States, or some states in the US, do it, we don’t have to. But it’s not just the US; I listed many other examples across the globe. The point is that this is becoming the norm globally. We’re getting left behind. And he said that this motion raises more questions than answers. So, could I ask him: would he agree to meet with medical advisers, endorsing the comment made by Leanne Wood, including Professor Barnes, to discuss the evidence to date on cannabis for medicinal use? We’ve all heard about the work of the all-party parliamentary group. Well, Professor Michael Barnes found that, overall, there is good evidence for the use of cannabis in many important conditions that affect many thousands of disabled people in the UK. He said:

‘Generally, cannabis and cannabis products are safe and well tolerated. It is clear from this review that cannabis does have medicinal value’.

And he said:

‘We consider that the evidence firmly suggests that cannabis should be a legal product for medicinal use, as long as the quality of the product is guaranteed and the supply chain secured and that medical users are, as far as possible and practicable, entered into proper long term studies of both efficacy and side effects.’

That is what we are proposing.

On the basis of his report, the States of Jersey said it formed the basis for planned changes across both Jersey and Guernsey. So, again, I will conclude by asking the health Secretary: will the Welsh Government agree to meet medical advisers, including Professor Barnes, to discuss the evidence to date on cannabis for medical use and to look at the detailed work across seven months by our colleagues in Westminster and the very detailed and evidenced-based international study that Professor Barnes conducted? Thank you very much.

The proposal is to agree the motion. Does any Member object? [Objection.] I will defer voting until voting time.

Voting deferred until voting time.